Provider Demographics
NPI:1114009792
Name:LEI, WINNIE (OD)
Entity Type:Individual
Prefix:DR
First Name:WINNIE
Middle Name:
Last Name:LEI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 COACH LN
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8448
Mailing Address - Country:US
Mailing Address - Phone:530-677-8809
Mailing Address - Fax:530-677-7570
Practice Address - Street 1:3420 COACH LN
Practice Address - Street 2:SUITE 1
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8448
Practice Address - Country:US
Practice Address - Phone:530-677-8809
Practice Address - Fax:530-677-7570
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6231890001Medicare NSC
CAP00898406Medicare PIN