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General NPI Number Information
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NPI Number | 1982263117
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Entity Type | Individual
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Provider Name | KATHERINE SUSANNAH MARY THOMAS OD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 619 S MARION AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-5808
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Country | US
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Telephone | 386-755-3016
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Fax |
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Provider Business Mailing Address
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Address Line | 7006 CANDLEWICK DR NE
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-1453
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Country | US
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Telephone | 319-210-1487
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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 | 096820
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License Number State | IA
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