Healthcare Provider Details

I. General information

NPI: 1588714646
Provider Name (Legal Business Name): WHITFIELD EUGENE WARMOUTH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NE FRONT ST
MILFORD DE
19963-1430
US

IV. Provider business mailing address

805 SPRUCE AVE
MILFORD DE
19963-1334
US

V. Phone/Fax

Practice location:
  • Phone: 302-422-5155
  • Fax: 302-422-5118
Mailing address:
  • Phone: 302-422-6955
  • Fax: 302-422-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI30001122
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: