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General NPI Number Information
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NPI Number | 1437200516
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Entity Type | Individual
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Provider Name | BERRY ALLEN HARRIS OD
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2807 N VERMILION ST STE 4
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City | DANVILLE
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State | IL
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Zip | 61832-1444
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Country | US
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Telephone | 217-446-5554
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Fax | 217-446-5554
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Provider Business Mailing Address
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Address Line | 5184 N 15TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47805-1639
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Country | US
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Telephone | 812-466-9130
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Fax | 217-446-5554
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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 | 046-8471
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License Number State | IL
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