Provider Demographics
NPI:1336397470
Name:DR. DIRK J WARNER OD, INC.
Entity Type:Organization
Organization Name:DR. DIRK J WARNER OD, INC.
Other - Org Name:WARNER EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-823-2934
Mailing Address - Street 1:760 S SAWBURG AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2767
Mailing Address - Country:US
Mailing Address - Phone:330-821-4362
Mailing Address - Fax:330-821-4348
Practice Address - Street 1:760 S SAWBURG AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2767
Practice Address - Country:US
Practice Address - Phone:330-821-4362
Practice Address - Fax:330-821-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 4886 T 1751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6440010001Medicare NSC