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General NPI Number Information
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NPI Number | 1689653354
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Entity Type | Individual
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Provider Name | BERNARD JEFFREY PULK O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 301 CHERRY HEIGHTS RD
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City | THE DALLES
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State | OR
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Zip | 97058-3586
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Country | US
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Telephone | 541-296-1101
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Fax | 541-298-1538
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Provider Business Mailing Address
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Address Line | 2025 CASCADE AVE STE 101
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City | HOOD RIVER
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State | OR
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Zip | 97031-1272
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Country | US
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Telephone | 541-386-2402
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Fax | 541-308-0293
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | AT3526
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | AT3526
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | AT3526
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | AT3526
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | AT3526
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License Number State | OR
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Taxonomy #6
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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