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General NPI Number Information
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NPI Number | 1699972968
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Entity Type | Individual
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Provider Name | JEREMY ALLEN ELMORE O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 735 WHITFIELD DR
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City | COLUMBUS
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State | IN
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Zip | 47201-2611
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Country | US
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Telephone | 812-375-9439
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Fax |
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Provider Business Mailing Address
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Address Line | 1352 ECHO BEND ST
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City | GREENWOOD
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State | IN
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Zip | 46142-1119
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Country | US
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Telephone | 317-908-8548
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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 | 18003454A
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License Number State | IN
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