Provider Demographics
NPI:1558341768
Name:WARNER, DIRK JASON (OD)
Entity Type:Individual
Prefix:MR
First Name:DIRK
Middle Name:JASON
Last Name:WARNER
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 1:760 S SAWBURG AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2767
Mailing Address - Country:US
Mailing Address - Phone:330-821-4362
Mailing Address - Fax:330-821-4348
Practice Address - Street 1:760 S SAWBURG AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2767
Practice Address - Country:US
Practice Address - Phone:330-821-4362
Practice Address - Fax:330-821-4348
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4886T1751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH48791OtherDAVIS VISION
OH08312OtherSPECTRA
OH1336397470OtherNPI
OH1336397470OtherNPI
OH08312OtherSPECTRA
OH6440010001Medicare NSC
U67685Medicare UPIN