Healthcare Provider Details

I. General information

NPI: 1811922644
Provider Name (Legal Business Name): ROBERT H WARREN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5653 COLUMBIA PIKE SUITE 101
BAILEYS CROSSROADS VA
22041-2872
US

IV. Provider business mailing address

5653 COLUMBIA PIKE SUITE 101
BAILEYS CROSSROADS VA
22041-2872
US

V. Phone/Fax

Practice location:
  • Phone: 703-578-3600
  • Fax: 703-379-6089
Mailing address:
  • Phone: 703-578-3600
  • Fax: 703-379-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000416
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: