Provider Demographics
NPI:1205366333
Name:WINK VISION
Entity Type:Organization
Organization Name:WINK VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OD
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VENDITTIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-728-4463
Mailing Address - Street 1:14688 NINA CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:VA
Mailing Address - Zip Code:20197-1635
Mailing Address - Country:US
Mailing Address - Phone:540-336-2073
Mailing Address - Fax:
Practice Address - Street 1:1201 WOLF ROCK DR STE 185
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-5841
Practice Address - Country:US
Practice Address - Phone:540-441-3719
Practice Address - Fax:540-235-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2018-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty