Healthcare Provider Details

I. General information

NPI: 1841381118
Provider Name (Legal Business Name): WARWICK C DELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 HIXSON PIKE
HIXSON TN
37343-1801
US

IV. Provider business mailing address

8151 HIXSON PIKE
HIXSON TN
37343-1801
US

V. Phone/Fax

Practice location:
  • Phone: 423-847-0498
  • Fax: 423-847-0499
Mailing address:
  • Phone: 423-847-0498
  • Fax: 423-847-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTN1519
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3098062
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerBLUECROSSBLUESHIELDNUMBER
# 2
Identifier4266950001
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerMEDICAREDEMPOS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: