Provider Demographics
NPI:1659471340
Name:WARREN, STEPHEN EUGENE IX (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EUGENE
Last Name:WARREN
Suffix:IX
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 1:305 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3805
Mailing Address - Country:US
Mailing Address - Phone:985-732-5181
Mailing Address - Fax:
Practice Address - Street 1:305 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3805
Practice Address - Country:US
Practice Address - Phone:985-732-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA756-192T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1139050Medicaid
LA1139050Medicaid
LA49352Medicare ID - Type Unspecified