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General NPI Number Information
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NPI Number | 1144319195
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Entity Type | Organization
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Legal Business Name | VIRGINIA EYE CLINIC, PLLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 2413 WARDS RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2103
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Country | US
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Telephone | 434-239-5323
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Fax | 434-239-1388
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Provider Business Mailing Address
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Address Line | 2413 WARDS RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2103
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Country | US
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Telephone | 434-239-5323
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Fax | 434-239-1388
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY J WILSON
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Credential | O.D.
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Telephone | 434-239-5323
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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 | 06180000530
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License Number State | VA
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