Provider Demographics
NPI:1881688943
Name:WARREN, HUBERT HOLMAN JR (OD)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:HOLMAN
Last Name:WARREN
Suffix:JR
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:PO BOX 1508
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335-1508
Mailing Address - Country:US
Mailing Address - Phone:910-892-7197
Mailing Address - Fax:910-892-6507
Practice Address - Street 1:601 W BROAD ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4861
Practice Address - Country:US
Practice Address - Phone:910-892-7197
Practice Address - Fax:910-892-6507
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909960Medicaid
NC09960OtherNC BCBS
T64714Medicare UPIN
NC8909960Medicaid