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General NPI Number Information
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NPI Number | 1730089459
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Entity Type | Individual
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Provider Name | ABANOB SAMWIL OD
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Gender | Male
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 3998 FAIR RIDGE DR STE 105
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City | FAIRFAX
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State | VA
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Zip | 22033-2980
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Country | US
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Telephone | 571-349-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 14824 BOLTON RD
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City | CENTREVILLE
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State | VA
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Zip | 20121-4499
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Country | US
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Telephone | 703-622-2939
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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 | 0618003688
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License Number State | VA
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