Provider Demographics
NPI:1225209109
Name:LYNDA D. WINTER
Entity Type:Organization
Organization Name:LYNDA D. WINTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:209-955-7570
Mailing Address - Street 1:622 LINCOLN CTR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-2640
Mailing Address - Country:US
Mailing Address - Phone:209-955-7570
Mailing Address - Fax:209-955-7580
Practice Address - Street 1:622 LINCOLN CTR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2640
Practice Address - Country:US
Practice Address - Phone:209-955-7570
Practice Address - Fax:209-955-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD4469332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0311710002Medicare NSC
CAA51625Medicare PIN