Individual
DR. RUSSELL ALAN WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
601 W BROAD ST, DUNN, NC 28334-4861
(910) 892-7197
(910) 892-6507
Mailing address
601 W BROAD ST, DUNN, NC 28334-4861
(910) 892-7197
(910) 892-6507
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1841
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093HN
NC BCBS
NC
05
—
89093HN
—
NC
Enumeration date
09/06/2005
Last updated
11/28/2011
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