Basic Information
| Provider Information | |||||||||
| NPI: | 1710131685 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOBSON OPTOMETRIC EYECARE, PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | DR. TERENCE M. WARREN, O.D. | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 247 | ||||||||
| Address2: | DOBSON OPTOMETRIC EYECARE | ||||||||
| City: | DOBSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363868526 | ||||||||
| FaxNumber: | 3363868526 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 S. MAIN STREET | ||||||||
| Address2: | DOBSON OPTOMETRIC EYECARE | ||||||||
| City: | DOBSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363868526 | ||||||||
| FaxNumber: | 3363864180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 09/08/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WARREN | ||||||||
| AuthorizedOfficialFirstName: | TERENCE | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3363868526 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1136 | NC | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | NC1136 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 8909953 | 05 | NC | MEDICAID | 1427016831 | 01 | NC | BCBS | OTHER | 1427016831 | 05 | NC | MEDICAID |