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General NPI Number Information
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NPI Number | 1891766606
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Entity Type | Individual
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Provider Name | JON SCOTT WALKER OD, MS, FAAO
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 10300 SOUTHSIDE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0743
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Country | US
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Telephone | 904-363-8282
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Fax | 904-363-2263
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Provider Business Mailing Address
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Address Line | 1923 WOODLAKE DR
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City | ORANGE PARK
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State | FL
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Zip | 32003-7227
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Country | US
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Telephone | 904-553-2426
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Fax | 904-363-2263
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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 | 3558
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License Number State | FL
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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 | 2011
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License Number State | MN
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