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General NPI Number Information
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NPI Number | 1508086166
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Entity Type | Individual
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Provider Name | MARLIN B NEIL O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12312 OLIVE BLVD STE 150
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5468
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Country | US
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Telephone | 314-336-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 7079 POST COACH DR
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City | O FALLON
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State | MO
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Zip | 63368-6017
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Country | US
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Telephone | 636-978-5112
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TO2930
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License Number State | MO
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