Provider Demographics
NPI:1023199379
Name:WARREN EYE CARE CENTER LLC
Entity Type:Organization
Organization Name:WARREN EYE CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LADAWN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-376-5444
Mailing Address - Street 1:100 S CASTLEROCK LN
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4586
Mailing Address - Country:US
Mailing Address - Phone:405-376-5444
Mailing Address - Fax:
Practice Address - Street 1:100 S CASTLEROCK LN
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4586
Practice Address - Country:US
Practice Address - Phone:405-376-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK2353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00959625OtherPPO OKLAHOMA
OK445828805003OtherBLUE CROSS BLUE SHIELD
OK7603576OtherAETNA
OK00959625OtherPPO OKLAHOMA