Provider Demographics
NPI:1972578391
Name:WARREN, BETH LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:LEIGH
Last Name:WARREN
Suffix:
Gender:F
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 1189
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-1189
Mailing Address - Country:US
Mailing Address - Phone:336-983-4313
Mailing Address - Fax:336-983-3913
Practice Address - Street 1:306 KIRBY RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9493
Practice Address - Country:US
Practice Address - Phone:336-983-4313
Practice Address - Fax:336-983-3913
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890901LMedicaid
NC0901LOtherBLUE CROSS BLUE SHIELD
NC2203375OtherUNITED HEALTHCARE
NC410044238OtherRAILROAD MEDICARE
NCNC1631OtherEYEMED
NCNC1631OtherEYEMED
NCNC1631OtherEYEMED
NC2203375OtherUNITED HEALTHCARE
NC24435OtherPARTNERS
NC7348394002OtherOPTICARE EYE HEALTH NETWK
NC1282830001Medicare NSC
NC2203375OtherUNITED HEALTHCARE
NC0090724OtherVISION CARE ADVANTAGE