Provider Demographics
NPI:1326691437
Name:JAMES E WINNICK OD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAMES E WINNICK OD PROFESSIONAL CORPORATION
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:URQUIDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-847-3051
Mailing Address - Street 1:141 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-2946
Mailing Address - Country:US
Mailing Address - Phone:209-847-3051
Mailing Address - Fax:209-847-1405
Practice Address - Street 1:141 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-2946
Practice Address - Country:US
Practice Address - Phone:209-847-3051
Practice Address - Fax:209-847-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0120160Medicaid