MEDICARE: TRENTON G. WARNER 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	100-152	ID
2	152W00000X	Optometrist	46009990	IL
3	152W00000X	Optometrist	1774	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184823049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENTON G. WARNER O.D.

Provider Business Mailing Address
First Line	:	1108 S WASHINGTON AVE
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-3535
Country	:	US
Telephone Number	:	208-365-2020
Fax Number	:	208-365-3854

Provider Business Practice Location Address
First Line	:	1108 S WASHINGTON AVE
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-3535
Country	:	US
Telephone Number	:	208-365-2020
Fax Number	:	208-365-3854

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	10/10/2014

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