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General NPI Number Information
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NPI Number | 1528735693
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Entity Type | Individual
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Provider Name | STIVIA DEMIRI OD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 24 WEBSTER PL
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City | BROOKLINE
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State | MA
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Zip | 02445-7937
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Country | US
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Telephone | 617-202-2020
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Fax | 617-734-3264
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Provider Business Mailing Address
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Address Line | 419 FELLSWAY E
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City | MALDEN
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State | MA
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Zip | 02148-2326
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Country | US
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Telephone | 781-321-8229
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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 | 5629
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 030.0133949
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License Number State | VT
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