Provider Demographics
NPI:1124012380
Name:WARREN EYE CARE OPTOMETRY PA
Entity type:Organization
Organization Name:WARREN EYE CARE OPTOMETRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-892-7197
Mailing Address - Street 1:601 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4861
Mailing Address - Country:US
Mailing Address - Phone:910-892-7197
Mailing Address - Fax:910-892-6507
Practice Address - Street 1:601 W BROAD ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4859
Practice Address - Country:US
Practice Address - Phone:910-892-7197
Practice Address - Fax:910-892-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013UMOtherNC BCBS
NC89013UMMedicaid
NC4514770001Medicare NSC
NC2471949Medicare ID - Type Unspecified