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General NPI Number Information
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NPI Number | 1902356157
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Entity Type | Individual
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Provider Name | MICHELLE MY LE O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 6475 OLD BEULAH ST
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City | ALEXANDRIA
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State | VA
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Zip | 22315-3723
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Country | US
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Telephone | 703-822-0570
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Fax | 703-548-0133
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Provider Business Mailing Address
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Address Line | 1502 MOUNT VERNON AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22301-1718
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Country | US
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Telephone | 703-548-0122
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Fax | 703-548-0133
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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 | 0618002529
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License Number State | VA
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