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General NPI Number Information
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NPI Number | 1447456827
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Entity Type | Individual
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Provider Name | SANJEET KAUR VIRK O.D
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 619 S MARION AVE (LAKE CITY VAMC)
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City | LAKE CITY
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State | FL
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Zip | 32025-5808
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Country | US
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Telephone | 386-755-3016
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Fax |
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Provider Business Mailing Address
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Address Line | 2602 GILSOM CT
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City | ORLANDO
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State | FL
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Zip | 32835-6154
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Country | US
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Telephone | 407-952-9681
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4242
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License Number State | FL
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