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General NPI Number Information
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NPI Number | 1750340535
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Entity Type | Individual
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Provider Name | MARK DURWOOD STEPHENSON V
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30710 ROUTE 9 SUITE 1501
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-780-3000
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Fax | 732-780-1235
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Provider Business Mailing Address
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Address Line | 84 STILLWELLS CORNER RD
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City | FREEHOLD
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State | NJ
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Zip | 07728-3304
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Country | US
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Telephone | 732-294-4857
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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 | 27TO00108200
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License Number State | NJ
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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 | 27OA00566000
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License Number State | NJ
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