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General NPI Number Information
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NPI Number | 1598862294
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Entity Type | Individual
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Provider Name | MARY F GANSARSKI O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2600 OLD ROUTE 220 N
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City | ALTOONA
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State | PA
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Zip | 16601-9328
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Country | US
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Telephone | 814-944-9888
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Fax | 814-949-8993
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Provider Business Mailing Address
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Address Line | 128 LAYTON LN
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City | JOHNSTOWN
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State | PA
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Zip | 15904-4018
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Country | US
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Telephone | 814-269-2157
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Fax | 814-949-8993
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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 | OET-008941
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License Number State | PA
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