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General NPI Number Information
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NPI Number | 1669441747
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS BYWATER O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 216 ROUTE 299 SUITE 4
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City | HIGHLAND
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State | NY
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Zip | 12528-7517
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Country | US
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Telephone | 845-691-8890
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Fax | 845-834-3224
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Provider Business Mailing Address
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Address Line | 216 ROUTE 299 SUITE 4
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City | HIGHLAND
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State | NY
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Zip | 12528-7517
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Country | US
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Telephone | 845-691-8890
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Fax | 845-834-3224
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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 | TUV4980
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License Number State | NY
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