Provider Demographics
NPI:1629530159
Name:MORTON, WARREN (OD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:MORTON
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 1:1607 GRAND AVE UNIT 31
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3873
Mailing Address - Country:US
Mailing Address - Phone:970-928-0105
Mailing Address - Fax:
Practice Address - Street 1:1607 GRAND AVE UNIT 31
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3873
Practice Address - Country:US
Practice Address - Phone:970-928-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0618002762152W00000X
CO0003626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program