=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376762195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARREN OPHTHALMOLOGY ASSOCIATES, CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 10/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3921 E MARKET ST
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44484-4711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-856-3300
-----------------------------------------------------
Fax | 330-856-4539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3921 E MARKET ST
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44484-4711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-856-3300
-----------------------------------------------------
Fax | 330-856-4539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ZAFAR A SHEIK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 330-856-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3599T401
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4982T1852
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 35079785S
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------