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General NPI Number Information
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NPI Number | 1598764672
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Entity Type | Individual
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Provider Name | MARC EDWARD BROCKMAN OD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 1515 N FLAGLER DR SUITE 500
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3428
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Country | US
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Telephone | 561-659-9700
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Fax | 561-659-7153
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Provider Business Mailing Address
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Address Line | 1050 SE MONTEREY RD SUITE 104
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City | STUART
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State | FL
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Zip | 34994-4512
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Country | US
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Telephone | 772-283-2020
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Fax | 772-220-9582
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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 | OPT3093
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License Number State | FL
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