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General NPI Number Information
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NPI Number | 1336210483
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Entity Type | Organization
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Legal Business Name | FEDERAL WAY VISION CENTER
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 32717 1ST AVE S SUITE 6
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5758
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Country | US
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Telephone | 253-838-5428
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Fax | 253-838-0875
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Provider Business Mailing Address
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Address Line | 32717 1ST AVE S SUITE 6
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5758
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Country | US
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Telephone | 253-838-5428
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Fax | 253-838-0875
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SHARON MANSKE
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Credential |
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Telephone | 253-838-5428
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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 | OD00001448TX
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License Number State | WA
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