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General NPI Number Information
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NPI Number | 1245628577
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Entity Type | Organization
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Legal Business Name | SPENCER FAMILY EYE CARE, LLC
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 2799 ROSE STREET
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City | FORT MEADE
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State | MD
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Zip | 20755
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Country | US
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Telephone | 703-342-8889
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Fax |
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Provider Business Mailing Address
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Address Line | 5970 LOGANS WAY
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-7507
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Country | US
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Telephone | 703-342-8889
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ALEXIS DANIELLE SPENCER
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Credential | O.D.
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Telephone | 703-342-8889
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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 | TA2438
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License Number State | MD
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