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General NPI Number Information
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NPI Number | 1720646193
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Entity Type | Individual
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Provider Name | COLIN LEE OD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | W180N8000 TOWN HALL RD
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-4002
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Country | US
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Telephone | 262-532-3271
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 W 33RD PL
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City | CHICAGO
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State | IL
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Zip | 60608-6459
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Country | US
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Telephone | 312-927-3741
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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 | 046.011310
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3879-35
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License Number State | WI
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