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General NPI Number Information
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NPI Number | 1023199379
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Entity Type | Organization
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Legal Business Name | WARREN EYE CARE CENTER LLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 100 S CASTLEROCK LN
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City | MUSTANG
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State | OK
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Zip | 73064-4586
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Country | US
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Telephone | 405-376-5444
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S CASTLEROCK LN
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City | MUSTANG
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State | OK
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Zip | 73064-4586
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Country | US
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Telephone | 405-376-5444
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. MARCIA LADAWN WARREN
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Credential | OD
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Telephone | 405-376-5444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OK2353
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License Number State | OK
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