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General NPI Number Information
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NPI Number | 1750076022
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Entity Type | Individual
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Provider Name | AMANDA KAY BOSCOE
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Gender | Female
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 2525 GREEN MOUNT COMMONS DR STE 290
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City | BELLEVILLE
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State | IL
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Zip | 62221-6735
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Country | US
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Telephone | 618-233-7800
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Fax | 618-233-7290
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Provider Business Mailing Address
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Address Line | PO BOX 207163
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City | DALLAS
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State | TX
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Zip | 75320-7163
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Country | US
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Telephone | 636-200-4393
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Fax | 636-527-0766
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 046.011272
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License Number State | IL
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