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General NPI Number Information
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NPI Number | 1568742633
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Entity Type | Individual
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Provider Name | PRIYANKA ERNST O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 245 STONEGATE RD
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City | ALGONQUIN
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State | IL
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Zip | 60102-5614
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Country | US
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Telephone | 847-658-0120
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 N THACKERAY DR
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City | PALATINE
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State | IL
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Zip | 60067-2750
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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 | 046010465
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License Number State | IL
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