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General NPI Number Information
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NPI Number | 1801149828
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Entity Type | Individual
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Provider Name | BUCK SVERDLIN O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 304 MANHATTAN AVE APT 2
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City | BROOKLYN
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State | NY
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Zip | 11211-3724
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Country | US
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Telephone | 310-895-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 1427 BERKELEY ST APT 7
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City | SANTA MONICA
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State | CA
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Zip | 90404-3200
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Country | US
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Telephone | 310-895-3422
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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 | 14553
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License Number State | CA
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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 | 007947
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License Number State | NY
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