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General NPI Number Information
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NPI Number | 1790500833
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Entity Type | Individual
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Provider Name | JOANNA LATEK OD
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Gender | Female
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 159 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10003-3067
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Country | US
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Telephone | 212-238-0950
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Fax | 646-843-7606
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Provider Business Mailing Address
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Address Line | 4738 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10040-1103
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Country | US
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Telephone | 800-936-0036
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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 | 0000011115
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License Number State | NY
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