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General NPI Number Information
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NPI Number | 1770637845
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Entity Type | Individual
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Provider Name | JASON D OGONOWSKI O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 42 3RD ST
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City | TROY
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State | NY
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Zip | 12180-3906
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Country | US
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Telephone | 518-274-8181
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Fax | 518-272-8164
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Provider Business Mailing Address
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Address Line | 42 3RD STREET
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City | TROY
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State | NY
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Zip | 12180-3906
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Country | US
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Telephone | 518-274-8181
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Fax | 518-272-8164
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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 | OPC003927
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License Number State | FL
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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 | TUV8372-1
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License Number State | NY
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