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General NPI Number Information
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NPI Number | 1275696056
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Entity Type | Individual
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Provider Name | PRESTON SULLIVAN MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 5201 OLYMPIC DR STE 110
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City | GIG HARBOR
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State | WA
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Zip | 98335-1778
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Country | US
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Telephone | 253-432-3238
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Fax | 253-509-0217
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Provider Business Mailing Address
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Address Line | 5201 OLYMPIC DR STE 110
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City | GIG HARBOR
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State | WA
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Zip | 98335-1778
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Country | US
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Telephone | 253-432-3238
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Fax | 253-509-0217
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD00044121
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License Number State | WA
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