MEDICARE: ANDREW WARREN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7165TG	TX

General Provider Information

NPI Number	:	1023203981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW WARREN O.D.

Provider Business Mailing Address
First Line	:	5401 SOUTH FM 1626
Second Line	:	SUITE 135-B
City	:	KYLE
State	:	TX
Zip	:	78640
Country	:	US
Telephone Number	:	512-268-8400
Fax Number	:	512-268-3096

Provider Business Practice Location Address
First Line	:	5401 SOUTH FM 1626
Second Line	:	SUITE 135-B
City	:	KYLE
State	:	TX
Zip	:	78640
Country	:	US
Telephone Number	:	512-268-8400
Fax Number	:	512-268-3096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	12/13/2007

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