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General NPI Number Information
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NPI Number | 1114988862
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Entity Type | Individual
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Provider Name | GARY LEE MANCIL O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1601 BRENNER AVE HEFNER VA MEDICAL CENTER (11-I)
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City | SALISBURY
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State | NC
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Zip | 28144-2515
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Country | US
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Telephone | 704-638-9000
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Fax | 704-638-3868
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Provider Business Mailing Address
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Address Line | 630 EASTLAND LN
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City | SALISBURY
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State | NC
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Zip | 28146-8131
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Country | US
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Telephone | 704-279-9126
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Fax |
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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 | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 1052
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License Number State | GA
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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 | 871
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License Number State | TN
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