Provider Demographics
NPI:1891995460
Name:WARREN EYE CARE, P.C.
Entity Type:Organization
Organization Name:WARREN EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BIENEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-745-5151
Mailing Address - Street 1:205 W JOHNSON AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WARREN
Mailing Address - State:MN
Mailing Address - Zip Code:56762-1118
Mailing Address - Country:US
Mailing Address - Phone:218-745-5151
Mailing Address - Fax:218-745-6000
Practice Address - Street 1:205 W JOHNSON AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:WARREN
Practice Address - State:MN
Practice Address - Zip Code:56762-1118
Practice Address - Country:US
Practice Address - Phone:218-745-5151
Practice Address - Fax:218-745-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN779407000Medicaid
MNU92546Medicare UPIN
CO3927Medicare PIN
MN5450970001Medicare NSC