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General NPI Number Information
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NPI Number | 1770666521
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Entity Type | Individual
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Provider Name | CARRIE DIVIN O. D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1521 NORTH INTERSTATE HIGHWAY 35
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City | BELLMEAD
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State | TX
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Zip | 76705
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Country | US
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Telephone | 254-867-1957
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Fax | 254-867-8445
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Provider Business Mailing Address
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Address Line | 267 BOLTON CIR
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City | WEST
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State | TX
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Zip | 76691-2400
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Country | US
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Telephone | 254-867-1957
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Fax | 254-867-8445
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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 | 5927 TG
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License Number State | TX
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