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General NPI Number Information
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NPI Number | 1518410745
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Entity Type | Individual
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Provider Name | MICHAEL PAVELL O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/23/2016
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Last Update Date | 07/23/2016
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Provider Practice Location Address
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Address Line | 5406 W 38TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-2918
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Country | US
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Telephone | 219-242-2423
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 PRENTISS DR
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City | VALPARAISO
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State | IN
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Zip | 46385-2894
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Country | US
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Telephone |
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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 | 18003991AB
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License Number State | IN
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