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General NPI Number Information
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NPI Number | 1093711640
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Entity Type | Individual
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Provider Name | MICHAEL GARY COHEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4680 KING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1215
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Country | US
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Telephone | 703-845-1404
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Fax | 703-845-5945
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Provider Business Mailing Address
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Address Line | 9814 SUMMERDAY DR
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City | BURKE
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State | VA
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Zip | 22015-4027
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Country | US
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Telephone | 703-425-6851
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Fax | 703-425-3560
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 0618000156
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 0618000156
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License Number State | VA
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