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Individual

ANTON VLASOV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
2817 REILLY ST, FORT BRAGG, NC 28310-0004
(910) 907-6001
Mailing address
6200 FAUVETTE LN, HOLLY SPRINGS, NC 27540-6443
(248) 854-5230

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
1489
NE
207W00000X
Ophthalmology Physician
Primary
2017-02607
NC

Other

Enumeration date
06/15/2013
Last updated
04/02/2018
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