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General NPI Number Information
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NPI Number | 1013296581
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Entity Type | Organization
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Legal Business Name | REPKO FAMILY VISION CENTER, PLLC
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 241 GATEWAY PLZ SUITE 106
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City | GATE CITY
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State | VA
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Zip | 24251-3350
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Country | US
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Telephone | 276-690-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 241 GATEWAY PLZ SUITE 106
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City | GATE CITY
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State | VA
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Zip | 24251-3350
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Country | US
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Telephone | 276-690-2345
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MELISSA G REPKO
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Credential | OD
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Telephone | 276-690-2345
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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 |
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License Number State | VA
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