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General NPI Number Information
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NPI Number | 1982972063
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Entity Type | Individual
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Provider Name | ANGEL KEITH RIVERA OD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 1310 PREACHER ROE BLVD # HGW
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City | WEST PLAINS
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State | MO
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Zip | 65775-2938
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Country | US
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Telephone | 787-510-5403
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1701
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City | WEST PLAINS
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State | MO
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Zip | 65775-7001
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Country | US
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Telephone | 787-510-5403
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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 | 2011037045
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License Number State | MO
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