Provider Demographics
NPI:1619037256
Name:WARSAW OPTICIANS, INC .
Entity type:Organization
Organization Name:WARSAW OPTICIANS, INC .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:585-786-5075
Mailing Address - Street 1:2447 STATE ROUTE 19 N
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-9336
Mailing Address - Country:US
Mailing Address - Phone:585-786-5075
Mailing Address - Fax:
Practice Address - Street 1:2447 STATE ROUTE 19 N
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9336
Practice Address - Country:US
Practice Address - Phone:585-786-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004826-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00963204Medicaid
NY7311143OtherINDEPENDENT HEALTH
NYNY4826OtherEYEMED
NY0027036801OtherUNIVERA
NY103131CTOtherPREFERRED CARE
NY0573080001Medicare NSC
156FX1800XMedicare PIN
NY00963204Medicaid