Basic Information
| Provider Information | |||||||||
| NPI: | 1427016831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | TERENCE | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DOBSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270178428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363868526 | ||||||||
| FaxNumber: | 3363864180 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DOBSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270178428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363868526 | ||||||||
| FaxNumber: | 3363864180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1136 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 2209140 | 01 | NC | UHC | OTHER | 8909953 | 05 | NC | MEDICAID | T64975 | 01 | NC | PRIMARY PHYSICIAN CARE | OTHER | 2208598 | 01 | NC | UHC MEDICARE COMPLETE | OTHER | 09953 | 01 | NC | BCBS | OTHER | 19903 | 01 | NC | PARTNERS | OTHER |