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General NPI Number Information
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NPI Number | 1881506723
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Entity Type | Individual
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Provider Name | MARISA VAN STADEN
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Gender | Female
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 14108 REDFISH LAKE CT
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City | CONROE
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State | TX
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Zip | 77384-2032
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Country | US
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Telephone | 617-938-9145
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Fax |
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Provider Business Mailing Address
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Address Line | 14108 REDFISH LAKE CT
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City | CONROE
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State | TX
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Zip | 77384-2032
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Country | US
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Telephone | 617-938-9145
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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 | 11778
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License Number State | TX
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