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NPI Code Detail

MEDICARE: TWIN CITY VISION PLLC

MEDICARE: TWIN CITY VISION PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1305S00000XPoint of ServiceDO 00002099WA

General Provider Information

NPI Number : 1891961165
Entity Type Code : Organization
Provider Name (Legal Business Name) : TWIN CITY VISION PLLC
Provider Business Mailing Address
First Line : 4503 OCEAN BEACH HWY
Second Line : SUITE 103
City : LONGVIEW
State : WA
Zip : 98632-5052
Country : US
Telephone Number : 360-636-6111
Fax Number : 360-636-4050
Provider Business Practice Location Address
First Line : 4503 OCEAN BEACH HWY
Second Line : SUITE 103
City : LONGVIEW
State : WA
Zip : 98632-5052
Country : US
Telephone Number : 360-636-6111
Fax Number : 360-636-4050
Authorized Official
Title or Position : OWNER
Name : DARREL MARSHALL
Credential : OPTICIAN
Telephone Number : 360-636-6111
Provider Enumeration Date : 05/06/2008
Last Update Date : 05/06/2008

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Directions to “TWIN CITY VISION PLLC ” Practice Location

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