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General NPI Number Information
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NPI Number | 1770694267
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Entity Type | Individual
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Provider Name | MARK LOUIS BUEHNERKEMPER O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 120 SOUTH MAIN STREET
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City | LAKEPORT
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State | CA
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Zip | 95453-5017
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Country | US
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Telephone | 707-263-4294
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Fax | 707-263-5180
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Provider Business Mailing Address
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Address Line | 3150 BELL HILL RD
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City | KELSEYVILLE
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State | CA
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Zip | 95451-8317
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Country | US
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Telephone | 707-279-1032
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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 | 10676
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License Number State | CA
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