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General NPI Number Information
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NPI Number | 1639266968
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Entity Type | Individual
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Provider Name | WENDE WAGGONER OD, MPH, MS
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 06/07/2017
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Provider Practice Location Address
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Address Line | 500 EUBANK BLVD SE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-3338
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Country | US
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Telephone | 505-323-2555
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Fax | 505-323-0888
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Provider Business Mailing Address
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Address Line | 135 W 27TH ST FL 4
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City | NEW YORK
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State | NY
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Zip | 10001-6226
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Country | US
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Telephone | 212-257-0007
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Fax | 646-219-5737
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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 | NM547
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License Number State | NM
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