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General NPI Number Information
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NPI Number | 1932535481
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Entity Type | Individual
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Provider Name | JASON SIDER O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 1400 S HAVANA ST
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City | AURORA
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State | CO
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Zip | 80012-4014
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Country | US
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Telephone | 303-481-3631
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Fax |
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Provider Business Mailing Address
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Address Line | 7906 E FREMONT AVE
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City | CENTENNIAL
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State | CO
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Zip | 80112-1823
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Country | US
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Telephone | 561-236-9347
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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 | OPT.003294
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License Number State | CO
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