=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548305394
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAYNE WARREN UNICE OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3849 S DELSEA DRIVE SUITE F 8
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-7409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-825-4283
-----------------------------------------------------
Fax | 856-825-1147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3849 S DELSEA DRIVE SUITE F 8
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-7409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-825-4283
-----------------------------------------------------
Fax | 856-825-1147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 270A00290600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27T000083100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------