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General NPI Number Information
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NPI Number | 1649504804
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Entity Type | Organization
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Legal Business Name | RIVER CITY VISION CENTER PA
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 13453 N MAIN ST STE 203
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2773
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Country | US
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Telephone | 904-696-2027
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Fax | 904-696-2028
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Provider Business Mailing Address
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Address Line | 13453 N MAIN ST STE 203
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2773
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Country | US
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Telephone | 904-696-2027
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Fax | 904-696-2028
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHANDRA M WILLIAMS
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Credential | OD
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Telephone | 334-467-9776
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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 | OPC4052
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 4196
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License Number State | FL
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