Provider Demographics
NPI:1548305394
Name:UNICE, WAYNE WARREN (OD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:WARREN
Last Name:UNICE
Suffix:
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 1:3849 S DELSEA DRIVE
Mailing Address - Street 2:SUITE F 8
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7409
Mailing Address - Country:US
Mailing Address - Phone:856-825-4283
Mailing Address - Fax:856-825-1147
Practice Address - Street 1:3849 S DELSEA DRIVE
Practice Address - Street 2:SUITE F 8
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7409
Practice Address - Country:US
Practice Address - Phone:856-825-4283
Practice Address - Fax:856-825-1147
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00290600152W00000X
NJ27T000083100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UN413156Medicare ID - Type Unspecified