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General NPI Number Information
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NPI Number | 1790754901
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Entity Type | Individual
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Provider Name | DAVID MICHAEL IMONDI O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | VA MEDICAL CENTER 555 WILLARD AVENUE
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City | NEWINGTON
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State | CT
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Zip | 06111
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Country | US
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Telephone | 860-667-6742
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Fax | 860-667-6833
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Provider Business Mailing Address
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Address Line | 57 BOURBON STREET
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074
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Country | US
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Telephone | 860-539-0584
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Fax | 860-652-3291
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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 | 002297
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License Number State | CT
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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 | 02297
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License Number State | CT
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