Provider Demographics
NPI:1477594497
Name:WARNER, DAVID J
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:WARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2105
Mailing Address - Country:US
Mailing Address - Phone:585-586-9110
Mailing Address - Fax:585-586-8647
Practice Address - Street 1:1801 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2105
Practice Address - Country:US
Practice Address - Phone:585-586-9110
Practice Address - Fax:585-586-8647
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC0032511156FX1800X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103052COtherPREFERRED CARE
NY103052COtherPREFERRED CARE