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General NPI Number Information
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NPI Number | 1780317453
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Entity Type | Individual
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Provider Name | AMIE GANDHI OD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 1200 W STATE ST FL 2
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City | ROCKFORD
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State | IL
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Zip | 61102-2112
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Country | US
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Telephone | 815-209-9642
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Fax | 815-918-8499
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Provider Business Mailing Address
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Address Line | 395 POLO CLUB DR
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139-2189
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Country | US
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Telephone | 630-767-9362
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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 | 046.011637
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License Number State | IL
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