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General NPI Number Information
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NPI Number | 1972260909
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Entity Type | Organization
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Legal Business Name | MANDEL VISION CARE LLC
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 8730 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4710
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Country | US
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Telephone | 443-576-3076
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Fax | 667-401-6130
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Provider Business Mailing Address
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Address Line | 6820 WILLIAMSON AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-1549
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Country | US
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Telephone | 410-963-2977
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ALISA MANDEL
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Credential | OD
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Telephone | 410-654-1500
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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 |
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License Number State |
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