Provider Demographics
NPI:1750158713
Name:WARNER, ONESIMUS DEVON SR (LDO)
Entity type:Individual
Prefix:MR
First Name:ONESIMUS
Middle Name:DEVON
Last Name:WARNER
Suffix:SR
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1040 MALABAR RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3251
Mailing Address - Country:US
Mailing Address - Phone:321-723-2031
Mailing Address - Fax:321-723-2056
Practice Address - Street 1:1040 MALABAR RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3251
Practice Address - Country:US
Practice Address - Phone:321-723-2031
Practice Address - Fax:321-723-2056
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7135156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician