Provider Demographics
NPI:1669552998
Name:WARREN, MARCIA LADAWN (OD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LADAWN
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 1:100 S CASTLEROCK LN
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4586
Mailing Address - Country:US
Mailing Address - Phone:405-376-5444
Mailing Address - Fax:
Practice Address - Street 1:100 S CASTLEROCK LN
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4586
Practice Address - Country:US
Practice Address - Phone:405-376-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK2353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00959625OtherPPO OKLAHOMA
OK7603576OtherAETNA
OKU86576Medicare UPIN