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General NPI Number Information
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NPI Number | 1497989396
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Entity Type | Individual
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Provider Name | MARCUS ANDREW SIMONICH O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 417 MAIN ST SW
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City | RONAN
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State | MT
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Zip | 59864-2738
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Country | US
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Telephone | 406-676-3937
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1048 8704 DUBAY ROAD
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City | POLSON
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State | MT
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Zip | 59860
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Country | US
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Telephone | 406-749-0259
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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 | 807
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License Number State | MT
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