Provider Demographics
NPI:1134113475
Name:WARE, PAUL DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:WARE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 ANCHORIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9317
Mailing Address - Country:US
Mailing Address - Phone:336-848-1146
Mailing Address - Fax:
Practice Address - Street 1:1585 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6356
Practice Address - Country:US
Practice Address - Phone:366-474-7285
Practice Address - Fax:366-474-2277
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2472672Medicare ID - Type Unspecified
U94623Medicare UPIN