Provider Demographics
NPI:1144275314
Name:WARNECK, WILLIAM M JR (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:WARNECK
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2146 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5319
Mailing Address - Country:US
Mailing Address - Phone:850-785-4000
Mailing Address - Fax:850-769-6425
Practice Address - Street 1:2146 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5319
Practice Address - Country:US
Practice Address - Phone:850-785-4000
Practice Address - Fax:850-769-6425
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2865152W00000X, 152W00000X
TXOD04919T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U46378Medicare UPIN
FL20644AMedicare PIN