Provider Demographics
NPI:1275589244
Name:BETH WARREN
Entity Type:Organization
Organization Name:BETH WARREN
Other - Org Name:COMMUNITY EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-983-4313
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-1189
Mailing Address - Country:US
Mailing Address - Phone:336-983-4313
Mailing Address - Fax:336-983-3913
Practice Address - Street 1:306 KIRBY RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9493
Practice Address - Country:US
Practice Address - Phone:336-983-4313
Practice Address - Fax:336-983-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1361/0975152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1539870OtherUMWA
NC0143MOtherBCBS
NC237415449OtherTRICARE
NC790143MMedicaid