Provider Demographics
NPI:1033227251
Name:WARNER, PAUL ALAN (OD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALAN
Last Name:WARNER
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 1:2439 CHIMNEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1059
Mailing Address - Country:US
Mailing Address - Phone:865-694-9896
Mailing Address - Fax:423-745-1702
Practice Address - Street 1:1304 DECATUR PIKE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2418
Practice Address - Country:US
Practice Address - Phone:423-745-1702
Practice Address - Fax:423-745-1702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN743152W00000X
SC829152W00000X, 152W00000X
GA2283152W00000X, 152W00000X
TX2942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3598393OtherMEDICARE PTAN
TN3598393OtherMEDICARE PTAN
TN3598393Medicare Oscar/Certification
3598393Medicare Oscar/Certification
TN3598393Medicare PIN
TN3598393Medicare PIN