Provider Demographics
NPI:1518006303
Name:WAREN, JOHN WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY
Last Name:WAREN
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 1:2121 N TYLER
Mailing Address - Street 2:#302
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4900
Mailing Address - Country:US
Mailing Address - Phone:316-729-8600
Mailing Address - Fax:316-773-3160
Practice Address - Street 1:2121 N TYLER RD
Practice Address - Street 2:STE 302
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4900
Practice Address - Country:US
Practice Address - Phone:316-729-8600
Practice Address - Fax:316-773-3160
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651030OtherBCBS
KSP00901269Medicare PIN
KS065095Medicare PIN
KS5295520001Medicare NSC
KSY22948Medicare UPIN