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General NPI Number Information
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NPI Number | 1962527846
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Entity Type | Individual
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Provider Name | JISOO L SHIN O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 971 CENTRAL PARK AVE SUITE 5
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City | SCARSDALE
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State | NY
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Zip | 10583-3211
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Country | US
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Telephone | 914-723-7392
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Fax | 914-723-1004
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Provider Business Mailing Address
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Address Line | 46 HEATH PL
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City | HASTINGS ON HUDSON
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State | NY
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Zip | 10706-3619
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Country | US
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Telephone | 914-479-1578
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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 | 27OA00549600
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License Number State | NJ
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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 | 27TO00087000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T006053-1
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License Number State | NY
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