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General NPI Number Information
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NPI Number | 1720084346
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Entity Type | Individual
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Provider Name | MICHAEL D DEPAOLIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 169 RUE DE VL
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City | ROCHESTER
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State | NY
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Zip | 14618-5619
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Country | US
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Telephone | 585-271-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 16 RANDOM WOODS
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City | PITTSFORD
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State | NY
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Zip | 14534-1440
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Country | US
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Telephone | 585-586-1840
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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 | 4109
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TUV004109-0
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License Number State | NY
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