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1790877413 NPI number — VIVIAN MARIE FOUNTAIN O.D.

NPI Number: 1790877413
Health Care Provider/Practitioner: VIVIAN MARIE FOUNTAIN O.D.

Information about “1790877413” NPI (VIVIAN MARIE FOUNTAIN O.D.) exists in 1790877413 in HTML format HTML  |  1790877413 in plain Text format TXT  |  1790877413 in PDF (Portable Document Format) PDF  |  1790877413 in an XML format XML  formats.

NPI Number : 1790877413 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790877413",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FOUNTAIN",
    "FirstName": "VIVIAN",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MATTHEWS",
    "OtherFirstName": "VIVIAN",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "O.D.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1950 OLD GALLOWS RD STE 520",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VIENNA",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22182-3970",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "703-847-8899",
    "MailingAddressFaxNumber": "571-223-6780",
    "FirstLinePracticeLocationAddress": "130 ENTERPRISE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUMA",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "70360-2443",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "985-872-2020",
    "PracticeLocationAddressFaxNumber": "985-872-2069",
    "EnumerationDate": "09/29/2006",
    "LastUpdateDate": "03/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "MS638",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "MS 638",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "1804-738AT",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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