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General NPI Number Information
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NPI Number | 1497881627
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Entity Type | Individual
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Provider Name | KRISTIAN DAVID EDLUND O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 251 MARY ESTHER BLVD
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City | MARY ESTHER
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State | FL
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Zip | 32569-1678
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Country | US
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Telephone | 850-243-1160
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Fax | 850-244-2038
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Provider Business Mailing Address
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Address Line | 107 E MIRACLE STRIP PKWY
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City | MARY ESTHER
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State | FL
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Zip | 32569-1921
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Country | US
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Telephone | 850-243-3152
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Fax | 850-244-2038
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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 | OPC3335
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License Number State | FL
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