MEDICARE: WARREN EYE CARE, P.C.

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	2847	MN

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	:	1891995460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN EYE CARE, P.C.

Provider Business Mailing Address
First Line	:	205 W JOHNSON AVE
Second Line	:	SUITE #1
City	:	WARREN
State	:	MN
Zip	:	56762-1118
Country	:	US
Telephone Number	:	218-745-5151
Fax Number	:	218-745-6000

Provider Business Practice Location Address
First Line	:	205 W JOHNSON AVE
Second Line	:	SUITE #1
City	:	WARREN
State	:	MN
Zip	:	56762-1118
Country	:	US
Telephone Number	:	218-745-5151
Fax Number	:	218-745-6000

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. STACEY JEAN BIENEK
Credential	:	O.D.
Telephone Number	:	218-745-5151

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	10/31/2011

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Directions to “WARREN EYE CARE, P.C. ” Practice Location

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