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General NPI Number Information
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NPI Number | 1609124296
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS MONTENARE O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 541 CEDAR HILL AVE STE H
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City | WYCKOFF
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State | NJ
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Zip | 07481-2150
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Country | US
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Telephone | 631-455-7123
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Fax |
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Provider Business Mailing Address
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Address Line | 67 COTTAGE ST FL 1
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City | MIDLAND PARK
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State | NJ
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Zip | 07432-1953
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Country | US
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Telephone | 631-455-7123
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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 | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 27OA00641300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00641300
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License Number State | NJ
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