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General NPI Number Information
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NPI Number | 1427133362
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Entity Type | Individual
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Provider Name | MYRA S. KROKOFF O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 46 W SUNRISE HWY
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City | VALLEY STREAM
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State | NY
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Zip | 11581-1104
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Country | US
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Telephone | 516-791-5300
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Fax | 516-791-5391
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Provider Business Mailing Address
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Address Line | 3253 PERRY AVENUE
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City | OCEANSIDE
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State | NY
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Zip | 11572-4233
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Country | US
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Telephone | 516-536-9411
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Fax |
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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 | TUV4793
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License Number State | NY
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