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General NPI Number Information
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NPI Number | 1356166839
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Entity Type | Organization
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Legal Business Name | VISIONARY EYE CLINIC PLLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 1600 GRAND CENTRAL AVE
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City | VIENNA
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State | WV
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Zip | 26105-1059
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Country | US
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Telephone | 304-295-8561
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 GRAND CENTRAL AVE
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City | VIENNA
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State | WV
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Zip | 26105-1059
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Country | US
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Telephone | 765-993-5888
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAYLA JUNE CAMPBELL
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Credential | OD
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Telephone | 765-993-5888
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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 |
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License Number State |
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