Provider Demographics
NPI:1073509048
Name:WINAKOR, EUGENE ALAN (OD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:ALAN
Last Name:WINAKOR
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 1:22 SALEM TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6516
Mailing Address - Country:US
Mailing Address - Phone:860-889-5293
Mailing Address - Fax:860-889-6597
Practice Address - Street 1:22 SALEM TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6516
Practice Address - Country:US
Practice Address - Phone:860-889-5293
Practice Address - Fax:860-889-6597
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4023974Medicaid
P490586OtherOXFORD
OVO291OtherHEALTH NET
0482187OtherAETNA
090000740CT01OtherBCBS
722300OtherCONNECTICARE
3762811002OtherCIGNA
3762811002OtherCIGNA