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General NPI Number Information
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NPI Number | 1598719114
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Entity Type | Individual
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Provider Name | CAROL R KOLLARITS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 3509 BRIARFIELD BLVD
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City | MAUMEE
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State | OH
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Zip | 43537
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Country | US
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Telephone | 419-865-3866
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Fax | 419-865-3451
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Provider Business Mailing Address
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Address Line | 3509 BRIARFIELD BLVD
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City | MAUMEE
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State | OH
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Zip | 43537-9383
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Country | US
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Telephone | 419-865-3866
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Fax | 419-865-3451
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35032573
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License Number State | OH
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