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General NPI Number Information
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NPI Number | 1578614418
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Entity Type | Individual
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Provider Name | BEVERLY MARK O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 3251 20TH AVE STE 219
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1918
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Country | US
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Telephone | 415-566-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 2245 MORAGA ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-4232
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Country | US
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Telephone | 415-665-2809
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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 | 8535
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License Number State | CA
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