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General NPI Number Information
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NPI Number | 1386760247
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Entity Type | Organization
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Legal Business Name | POTOMAC EYE CENTER
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5411A BACKLICK RD
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3915
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Country | US
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Telephone | 703-256-2474
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Fax | 703-941-7938
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Provider Business Mailing Address
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Address Line | 5411A BACKLICK RD
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3915
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Country | US
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Telephone | 703-256-2474
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Fax | 703-941-7938
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS JAMES FRASER JR.
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Credential | M.D.
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Telephone | 703-256-2474
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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 | 0101023876
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License Number State | VA
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