Provider Demographics
NPI:1023798725
Name:WARREN, JOSEPH CALEB (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CALEB
Last Name:WARREN
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 1:26 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-2949
Mailing Address - Country:US
Mailing Address - Phone:662-489-5907
Mailing Address - Fax:662-489-6928
Practice Address - Street 1:26 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2949
Practice Address - Country:US
Practice Address - Phone:662-489-5907
Practice Address - Fax:662-489-6928
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1076152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist