Provider Demographics
NPI:1568573897
Name:WARNER, JOSEPH DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DEAN
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 1:5509 N PAULINA ST
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1113
Mailing Address - Country:US
Mailing Address - Phone:773-728-9068
Mailing Address - Fax:
Practice Address - Street 1:5222 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2377
Practice Address - Country:US
Practice Address - Phone:773-275-2538
Practice Address - Fax:773-275-0344
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist