Healthcare Provider Details

I. General information

NPI: 1033494182
Provider Name (Legal Business Name): WARREN WHITLEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 S MEADOWS PKWY STE 108
RENO NV
89521-4894
US

IV. Provider business mailing address

770 S MEADOWS PKWY STE 108
RENO NV
89521-4894
US

V. Phone/Fax

Practice location:
  • Phone: 775-451-3937
  • Fax: 775-360-6413
Mailing address:
  • Phone: 775-451-3937
  • Fax: 775-360-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number810
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: