Basic Information
| Provider Information | |||||||||
| NPI: | 1134306582 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WARREN EYE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 SOUTH FM 1626 | ||||||||
| Address2: | SUITE 135-B | ||||||||
| City: | KYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786406038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122688400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5401 SOUTH FM 1626 | ||||||||
| Address2: | SUITE 135-B | ||||||||
| City: | KYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786406038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122688400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 01/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | WARREN | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | DALE | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5122688400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7165TG | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.