Provider Demographics
NPI:1851617666
Name:WERNER OPTOMETRY, APC
Entity Type:Organization
Organization Name:WERNER OPTOMETRY, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-670-6296
Mailing Address - Street 1:2650 JAMACHA RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4319
Mailing Address - Country:US
Mailing Address - Phone:619-670-6296
Mailing Address - Fax:619-670-8852
Practice Address - Street 1:2650 JAMACHA RD
Practice Address - Street 2:SUITE 155
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4319
Practice Address - Country:US
Practice Address - Phone:619-670-6296
Practice Address - Fax:619-670-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9378152W00000X
CA13478152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851617666Medicaid