Provider Demographics
NPI:1912004391
Name:WARN, STANLEY (OD)
Entity Type:Individual
Prefix:MS
First Name:STANLEY
Middle Name:
Last Name:WARN
Suffix:
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 1:4836 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4524
Mailing Address - Country:US
Mailing Address - Phone:216-475-0552
Mailing Address - Fax:216-662-3894
Practice Address - Street 1:4836 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-4524
Practice Address - Country:US
Practice Address - Phone:216-475-0552
Practice Address - Fax:216-662-3894
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3577T693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist