Healthcare Provider Details

I. General information

NPI: 1750601845
Provider Name (Legal Business Name): LEAH M WARNER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 RIVER AVE
WILLIAMSPORT PA
17701-3722
US

IV. Provider business mailing address

88 HARDEES DR
MIFFLINBURG PA
17844-7062
US

V. Phone/Fax

Practice location:
  • Phone: 570-326-8070
  • Fax: 570-326-0396
Mailing address:
  • Phone: 570-966-5582
  • Fax: 570-966-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001955
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: