Healthcare Provider Details

I. General information

NPI: 1205955663
Provider Name (Legal Business Name): BRAD J WARONICKI, O.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 SE WILLOUGHBY BLVD
STUART FL
34994-4700
US

IV. Provider business mailing address

2626 SE WILLOUGHBY BLVD
STUART FL
34994-4700
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-4878
  • Fax: 772-286-4368
Mailing address:
  • Phone: 772-286-4878
  • Fax: 772-286-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 2404
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO 2488
License Number StateFL

VIII. Authorized Official

Name: DR. BRAD J WARONICKI
Title or Position: PRESIDENT
Credential: O.D.
Phone: 772-286-4878