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General NPI Number Information
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NPI Number | 1619318367
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Entity Type | Individual
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Provider Name | BRIAN HENRY WOLANIN O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 5065 MAIN ST # 1140
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City | TRUMBULL
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State | CT
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Zip | 06611-4204
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Country | US
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Telephone | 203-374-3211
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Fax | 203-374-9344
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Provider Business Mailing Address
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Address Line | 323 FAIRFIELD AVE APT 107
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City | BRIDGEPORT
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State | CT
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Zip | 06604-4295
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Country | US
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Telephone | 614-381-1331
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1773
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License Number State | SC
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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 | 2904
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License Number State | CT
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