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General NPI Number Information
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NPI Number | 1528117413
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Entity Type | Individual
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Provider Name | KERRI DAVIDOVE LEE OD
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8447 LAUREL CANYON BLVD
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City | SUN VALLEY
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State | CA
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Zip | 91352
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Country | US
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Telephone | 818-504-2020
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Fax | 818-504-2070
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Provider Business Mailing Address
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Address Line | 8447 LAUREL CANYON BLVD
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City | SUN VALLEY
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State | CA
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Zip | 91352
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Country | US
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Telephone | 818-504-2020
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Fax | 818-504-2070
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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 | OPT7786TPA
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License Number State | CA
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