=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356794697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARRENTON EYE ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2016
-----------------------------------------------------
Last Update Date | 05/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 FLETCHER DR
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20186-2183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-216-7632
-----------------------------------------------------
Fax | 540-216-7636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 508 FLETCHER DR
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20186-2183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-216-7632
-----------------------------------------------------
Fax | 540-216-7636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HEIDI F CALLADINE
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 540-931-1549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0618001691
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------