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General NPI Number Information
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NPI Number | 1194139972
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY VISION CARE, LLC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 331 GAMBRILLS RD SUITE 3
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City | GAMBRILLS
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State | MD
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Zip | 21054-1141
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Country | US
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Telephone | 443-351-8079
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Fax |
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Provider Business Mailing Address
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Address Line | 331 GAMBRILLS RD SUITE 3
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City | GAMBRILLS
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State | MD
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Zip | 21054-1141
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Country | US
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Telephone | 443-351-8079
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MICHELLE MAY
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Credential | O.D.
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Telephone | 443-351-8079
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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 | TA2234
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License Number State | MD
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