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General NPI Number Information
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NPI Number | 1982096525
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Entity Type | Individual
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Provider Name | SHANE MCDONALD O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 3303 SW BOND AVE FL 11
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City | PORTLAND
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State | OR
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Zip | 97239-4501
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Country | US
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Telephone | 503-494-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 6985 ROSEN LAKE RD. BOX 13
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City | JAFFRAY
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State | BRITISH COLUMBIA
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Zip | V0B1T0
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Country | CA
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Telephone | 503-707-0409
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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 | 3606ATI
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License Number State | OR
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