Provider Demographics
NPI:1578544888
Name:MAYHALL WARNER, MARY KATHLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY KATHLEEN
Middle Name:
Last Name:MAYHALL WARNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-4756
Mailing Address - Country:US
Mailing Address - Phone:256-767-5000
Mailing Address - Fax:256-767-6114
Practice Address - Street 1:318 E TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5716
Practice Address - Country:US
Practice Address - Phone:256-767-5000
Practice Address - Fax:256-767-6114
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-959-TA-543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000098696Medicaid
ALU90937Medicare UPIN
AL000098696WARMedicare ID - Type Unspecified