Provider Demographics
NPI:1588714646
Name:WARMOUTH, WHITFIELD EUGENE (OD)
Entity type:Individual
Prefix:
First Name:WHITFIELD
Middle Name:EUGENE
Last Name:WARMOUTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1334
Mailing Address - Country:US
Mailing Address - Phone:302-422-6955
Mailing Address - Fax:302-422-9683
Practice Address - Street 1:110 NE FRONT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1430
Practice Address - Country:US
Practice Address - Phone:302-422-5155
Practice Address - Fax:302-422-5118
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DET73232Medicare UPIN