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General NPI Number Information
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NPI Number | 1528144946
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Entity Type | Individual
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Provider Name | KEVIN ALBERT STAGMAN OD DR OF OPTOMETRY
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Gender | Male
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 222 WEST MCCOY BLVD
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City | TOMAH
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State | WI
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Zip | 54660
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Country | US
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Telephone | 608-372-1813
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Fax | 608-372-1824
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Provider Business Mailing Address
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Address Line | N 5179 COUNTY ROAD A
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City | WESTFIELD
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State | WI
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Zip | 53964
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Country | US
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Telephone | 608-296-1959
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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 | 2060
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License Number State | WI
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