Provider Demographics
NPI:1427016831
Name:WARREN, TERENCE MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:MICHAEL
Last Name:WARREN
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 1:220 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8428
Mailing Address - Country:US
Mailing Address - Phone:336-386-8526
Mailing Address - Fax:336-386-4180
Practice Address - Street 1:220 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8428
Practice Address - Country:US
Practice Address - Phone:336-386-8526
Practice Address - Fax:336-386-4180
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2209140OtherUHC
NC8909953Medicaid
NCT64975OtherPRIMARY PHYSICIAN CARE
NC2208598OtherUHC MEDICARE COMPLETE
NC09953OtherBCBS
NC19903OtherPARTNERS
NC2208598OtherUHC MEDICARE COMPLETE
NC246444AMedicare ID - Type Unspecified