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General NPI Number Information
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NPI Number | 1255830923
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Entity Type | Organization
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Legal Business Name | MONUMENT FAMILY EYE CARE, PLLC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 13630 HULL STREET RD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2108
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Country | US
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Telephone | 703-946-1382
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Fax |
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Provider Business Mailing Address
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Address Line | 13630 HULL STREET RD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | JOSEPH SCIULLO
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Credential | OD
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Telephone | 703-946-1382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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