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General NPI Number Information
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NPI Number | 1417083577
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Entity Type | Individual
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Provider Name | NICHOLAS PAUL MARCONI O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 166 SYCAMORE ST SUITE 150
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City | WILLISTON
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State | VT
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Zip | 05495-8217
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Country | US
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Telephone | 802-872-7447
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Fax | 802-872-7448
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Provider Business Mailing Address
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Address Line | 166 SYCAMORE ST SUITE 150
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City | WILLISTON
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State | VT
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Zip | 05495-8217
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Country | US
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Telephone | 802-872-7447
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Fax | 802-872-7448
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 030-0000260
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 030-0000260
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License Number State | VT
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