Basic Information
Provider Information
NPI: 1003001298
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WARREN
FirstName: KASEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5401 SOUTH FM 1626
Address2: SUITE 135
City: KYLE
State: TX
PostalCode: 78640
CountryCode: US
TelephoneNumber: 5122688400
FaxNumber:  
Practice Location
Address1: 5401 SOUTH FM 1626
Address2: SUITE 135
City: KYLE
State: TX
PostalCode: 78640
CountryCode: US
TelephoneNumber: 2812168193
FaxNumber: 5122683096
Other Information
ProviderEnumerationDate: 09/11/2007
LastUpdateDate: 12/10/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X7109TGTXY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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