Healthcare Provider Details

I. General information

NPI: 1124012380
Provider Name (Legal Business Name): WARREN EYE CARE OPTOMETRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W BROAD ST
DUNN NC
28334-4859
US

IV. Provider business mailing address

601 W BROAD ST
DUNN NC
28334-4861
US

V. Phone/Fax

Practice location:
  • Phone: 910-892-7197
  • Fax: 910-892-6507
Mailing address:
  • Phone: 910-892-7197
  • Fax: 910-892-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. HUBERT H WARREN JR.
Title or Position: PRESIDENT
Credential:
Phone: 910-892-7197