Provider Demographics
NPI:1629268883
Name:WARNER ROBINS OPTICAL, INC.
Entity Type:Organization
Organization Name:WARNER ROBINS OPTICAL, INC.
Other - Org Name:OLDHAM'S OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADDISON
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:MCREE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:478-746-4866
Mailing Address - Street 1:212A CORDER RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3604
Mailing Address - Country:US
Mailing Address - Phone:478-929-2020
Mailing Address - Fax:
Practice Address - Street 1:212A CORDER RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3604
Practice Address - Country:US
Practice Address - Phone:478-929-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLDHAM'S OPTICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO000695332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0683050001Medicare NSC