Provider Demographics
NPI:1265502397
Name:WINCHESTER, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 SW SCHOLLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1249
Mailing Address - Country:US
Mailing Address - Phone:503-203-8337
Mailing Address - Fax:
Practice Address - Street 1:7724 SW 31ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2420
Practice Address - Country:US
Practice Address - Phone:503-239-7733
Practice Address - Fax:503-232-0193
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21043207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130235Medicaid
ORR101507Medicare PIN
ORR165984Medicare PIN
ORF57934Medicare UPIN