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General NPI Number Information
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NPI Number | 1457312159
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Entity Type | Individual
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Provider Name | CELESTE LEWIS O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 226 FORT LN
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2220
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Country | US
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Telephone | 757-393-0976
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Fax |
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Provider Business Mailing Address
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Address Line | 2324 WOODHURST LN
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City | CHESAPEAKE
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State | VA
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Zip | 23322-3140
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Country | US
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Telephone | 757-560-2794
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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 | 0618000228
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License Number State | VA
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