1710131685 NPI number — DOBSON OPTOMETRIC EYECARE, PA

Table of content: (NPI 1710131685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710131685 NPI number — DOBSON OPTOMETRIC EYECARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOBSON OPTOMETRIC EYECARE, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. TERENCE M. WARREN, O.D.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710131685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 247
Provider Second Line Business Mailing Address:
DOBSON OPTOMETRIC EYECARE
Provider Business Mailing Address City Name:
DOBSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-386-8526
Provider Business Mailing Address Fax Number:
336-386-8526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 S. MAIN STREET
Provider Second Line Business Practice Location Address:
DOBSON OPTOMETRIC EYECARE
Provider Business Practice Location Address City Name:
DOBSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-386-8526
Provider Business Practice Location Address Fax Number:
336-386-4180
Provider Enumeration Date:
11/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
TERENCE
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-386-8526

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1136 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: NC1136 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8909953 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1427016831 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1427016831 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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