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General NPI Number Information
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NPI Number | 1871110783
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Entity Type | Individual
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Provider Name | GRACE ANDERSON OD, MS
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Gender | Female
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 2715 WILLETTA ST SW
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City | ALBANY
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State | OR
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Zip | 97321-3471
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Country | US
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Telephone | 208-392-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 2930 NE WEST DEVILS LAKE RD STE 2
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City | LINCOLN CITY
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State | OR
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Zip | 97367-5195
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Country | US
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Telephone | 541-614-0946
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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 | ATI4497
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License Number State | OR
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