Provider Demographics
NPI:1245205483
Name:AUGUSTINE, WYNETTE COOK (OD)
Entity Type:Individual
Prefix:DR
First Name:WYNETTE
Middle Name:COOK
Last Name:AUGUSTINE
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 1:1201 N ROSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3939
Mailing Address - Country:US
Mailing Address - Phone:714-528-2566
Mailing Address - Fax:714-993-5369
Practice Address - Street 1:1201 N ROSE DR STE 100
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3939
Practice Address - Country:US
Practice Address - Phone:714-528-2566
Practice Address - Fax:562-988-7032
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV226152W00000X
CA7929T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP7929CMedicare ID - Type Unspecified