Provider Demographics
NPI:1871846188
Name:WARRENTON EYE CENTER LLC
Entity Type:Organization
Organization Name:WARRENTON EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUP
Authorized Official - Middle Name:
Authorized Official - Last Name:PANJWANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-502-6075
Mailing Address - Street 1:3838 WATKINS MILL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6448
Mailing Address - Country:US
Mailing Address - Phone:904-502-6075
Mailing Address - Fax:904-207-7933
Practice Address - Street 1:700 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3828
Practice Address - Country:US
Practice Address - Phone:904-502-6075
Practice Address - Fax:904-207-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty