Provider Demographics
NPI:1336136464
Name:WINBERRY, JOSEPH PAUL JR (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:WINBERRY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KACEY COURT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055
Mailing Address - Country:US
Mailing Address - Phone:717-591-1234
Mailing Address - Fax:717-591-9112
Practice Address - Street 1:40 NOBLE BLVD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4122
Practice Address - Country:US
Practice Address - Phone:717-218-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00478900152W00000X
PAOET009052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U08217Medicare UPIN
PA507682Medicare ID - Type Unspecified