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General NPI Number Information
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NPI Number | 1871289579
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Entity Type | Individual
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Provider Name | BRADLEY MENDOZA OD
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Gender | Male
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 810 N VINEYARD BLVD
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City | HONOLULU
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State | HI
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Zip | 96817-3590
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Country | US
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Telephone | 808-201-3937
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 541
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City | LIHUE
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State | HI
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Zip | 96766-0541
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Country | US
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Telephone | 808-212-5699
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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 | OD-1004
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License Number State | HI
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