Provider Demographics
NPI:1356794697
Name:WARRENTON EYE ASSOCIATES
Entity type:Organization
Organization Name:WARRENTON EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:F
Authorized Official - Last Name:CALLADINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-931-1549
Mailing Address - Street 1:508 FLETCHER DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2183
Mailing Address - Country:US
Mailing Address - Phone:540-216-7632
Mailing Address - Fax:540-216-7636
Practice Address - Street 1:508 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2183
Practice Address - Country:US
Practice Address - Phone:540-216-7632
Practice Address - Fax:540-216-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7590930001Medicare PIN