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General NPI Number Information
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NPI Number | 1114292737
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Entity Type | Organization
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Legal Business Name | EYECARE CENTER CORP
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 4229 JEFFERSON OAKS CIR K
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City | FAIRFAX
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State | VA
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Zip | 22033-4071
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Country | US
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Telephone | 703-470-8274
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Fax |
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Provider Business Mailing Address
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Address Line | 3022 JAVIER RD SUITE 216
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City | FAIRFAX
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State | VA
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Zip | 22031-4645
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Country | US
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Telephone | 703-470-8274
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST / OPTICIAN
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Name | RITA ESTHER MONCAYO
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Credential | ABOC, LICENSED
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Telephone | 703-470-8274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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