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General NPI Number Information
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NPI Number | 1699829382
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Entity Type | Organization
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Legal Business Name | CASPER VISION CENTER PC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 543 S DAVID ST
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City | CASPER
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State | WY
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Zip | 82601-3196
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Country | US
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Telephone | 307-237-9494
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Fax | 307-237-1370
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Provider Business Mailing Address
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Address Line | 543 S DAVID ST
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City | CASPER
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State | WY
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Zip | 82601-3196
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Country | US
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Telephone | 307-237-9494
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Fax | 307-237-1370
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. PAUL L GUSTAFSON
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Credential | OD
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Telephone | 307-237-9494
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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 | 125T
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License Number State | WY
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