Provider Demographics
NPI:1083632640
Name:WINTER, DANIEL SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SCOTT
Last Name:WINTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:156 POWER CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-9416
Mailing Address - Country:US
Mailing Address - Phone:706-265-2368
Mailing Address - Fax:706-265-2377
Practice Address - Street 1:156 POWER CENTER DR
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-9416
Practice Address - Country:US
Practice Address - Phone:706-265-2368
Practice Address - Fax:706-265-2377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT002055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU86915Medicare UPIN