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General NPI Number Information
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NPI Number | 1588976336
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Entity Type | Individual
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Provider Name | AMANDA MARIE KELLER OD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 7050 WATTS RD
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City | MADISON
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State | WI
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Zip | 53719-1365
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Country | US
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Telephone | 608-274-4084
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Fax | 608-274-4031
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Provider Business Mailing Address
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Address Line | 7275 CLOVER HILL DR
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City | WAUNAKEE
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State | WI
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Zip | 53597-9451
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Country | US
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Telephone | 608-335-3221
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Fax | 608-274-4031
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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 | 3179-35
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License Number State | WI
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