Provider Demographics
NPI:1285637652
Name:WINICK, JEFFREY P (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:WINICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 DALLAS RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3680
Mailing Address - Country:US
Mailing Address - Phone:559-573-2845
Mailing Address - Fax:
Practice Address - Street 1:1165 DALLAS RD
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3680
Practice Address - Country:US
Practice Address - Phone:559-573-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46812207W00000X
WI50258-020207W00000X
IL036120884207W00000X
MO2008014399207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G468120Medicaid
330191636OtherFEDERAL TAX ID NUMBER
330191636OtherFEDERAL TAX ID NUMBER
CAWG46812AMedicare ID - Type UnspecifiedPPIN OCEANSIDE
CA00G468120Medicaid
CA180001915Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ILK51911Medicare PIN
CA180001915Medicare ID - Type UnspecifiedRAILROAD MEDICARE
CAW14836Medicare ID - Type UnspecifiedPROVIDER ID, OCEANSIDE
CA0821190001Medicare NSC