Healthcare Provider Details

I. General information

NPI: 1730543968
Provider Name (Legal Business Name): CHASE WARNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S 63RD ST
MESA AZ
85206-1619
US

IV. Provider business mailing address

PO BOX 200414
DALLAS TX
75320-0414
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-3937
  • Fax: 480-924-5094
Mailing address:
  • Phone: 480-641-3937
  • Fax: 480-924-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number008955
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: