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General NPI Number Information
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NPI Number | 1518064344
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Entity Type | Individual
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Provider Name | MARK ALAN GILBERT OD OPTOMETRIST
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1515 W PARADISE DR
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City | WEST BEND
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State | WI
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Zip | 53095
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Country | US
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Telephone | 262-334-8001
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Fax | 262-334-8028
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Provider Business Mailing Address
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Address Line | W179 N9867 RIVERSBEND CIRCLE EAST
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City | GERMANTOWN
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State | WI
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Zip | 53022-4652
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Country | US
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Telephone | 262-251-4084
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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 | 2118
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License Number State | WI
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