1699116376 NPI number — WARNER EYECARE, LLC

Table of content: (NPI 1699116376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699116376 NPI number — WARNER EYECARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARNER EYECARE, LLC
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:
Provider Other Organization Name Type Code:
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:
1699116376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5249 BERKSHIRE NORTH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46142-7755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-883-0071
Provider Business Mailing Address Fax Number:
317-883-0071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1642 OLIVE BRANCH PARKE LN # 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46143-9821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-883-0071
Provider Business Practice Location Address Fax Number:
317-883-0071
Provider Enumeration Date:
07/10/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WARNER
Authorized Official First Name:
AARON
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-883-0071

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18003007A,B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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