Provider Demographics
NPI:1205955663
Name:BRAD J WARONICKI, O.D., P.A.
Entity type:Organization
Organization Name:BRAD J WARONICKI, O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARONICKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:772-286-4878
Mailing Address - Street 1:2626 SE WILLOUGHBY BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4700
Mailing Address - Country:US
Mailing Address - Phone:772-286-4878
Mailing Address - Fax:772-286-4368
Practice Address - Street 1:2626 SE WILLOUGHBY BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4700
Practice Address - Country:US
Practice Address - Phone:772-286-4878
Practice Address - Fax:772-286-4368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2404152W00000X
FLDO 2488156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49671OtherDAVIS VISION
FL20272Other20272
FL168OtherMETCARE
FL168OtherMETCARE
FL20272Other20272