Basic Information
| Provider Information | |||||||||
| NPI: | 1003001298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | KASEY | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 SOUTH FM 1626 | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | KYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122688400 | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7109TG | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.