Provider Demographics
NPI:1942480512
Name:WANER FAMILY EYE CARE O.D., PLLC
Entity Type:Organization
Organization Name:WANER FAMILY EYE CARE O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WANER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-247-5489
Mailing Address - Street 1:1651 NEW BERN ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9635
Mailing Address - Country:US
Mailing Address - Phone:252-247-5489
Mailing Address - Fax:252-247-5823
Practice Address - Street 1:300 HWY 24
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2551
Practice Address - Country:US
Practice Address - Phone:252-247-5489
Practice Address - Fax:252-247-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty