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General NPI Number Information
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NPI Number | 1992729206
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Entity Type | Individual
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Provider Name | GERRIT H. DEVRIES O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 609 N HALLECK ST
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City | DEMOTTE
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State | IN
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Zip | 46310-9545
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Country | US
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Telephone | 219-987-3673
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Fax | 219-987-3905
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Provider Business Mailing Address
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Address Line | PO BOX 849
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City | DEMOTTE
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State | IN
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Zip | 46310-0849
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Country | US
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Telephone | 219-987-3673
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Fax | 219-987-3905
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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 | 18001809B
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 18001809B
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 18001809B
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 18001809B
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License Number State | IN
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