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General NPI Number Information
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NPI Number | 1437188182
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Entity Type | Individual
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Provider Name | RONALD ROBIN MATHISEN OD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5549 35TH ST NE
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City | BUFFALO
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State | MN
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Zip | 55313-3716
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Country | US
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Telephone | 763-682-9052
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Fax | 763-782-8100
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Provider Business Mailing Address
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Address Line | 5549 35TH ST NE
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City | BUFFALO
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State | MN
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Zip | 55313-3716
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Country | US
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Telephone | 763-682-9052
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Fax | 763-571-3008
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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 | 2147
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License Number State | MN
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