Provider Demographics
NPI:1346536562
Name:WINSTON, SAMUEL ASHER (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ASHER
Last Name:WINSTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8609 KINGSTON PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5103
Mailing Address - Country:US
Mailing Address - Phone:865-693-3441
Mailing Address - Fax:865-769-8272
Practice Address - Street 1:8609 KINGSTON PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5103
Practice Address - Country:US
Practice Address - Phone:865-693-3441
Practice Address - Fax:865-769-8272
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2983152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I416085OtherMEDICARE PTAN #
TN1346536562OtherBLUE CROSS BLUE SHIELD BLUE ADVANTAGE
TN1346536562OtherEYEMED
TN1525118Medicaid
TN1346536562OtherBLUE CROSS BLUE SHIELD BLUE NETWORK P
TN103G706085OtherMEDICARE PTAN GROUP #
TN1346536562OtherSUPERIOR
TN1346536562OtherBLUE CROSS BLUE SHIELD BLUE NETWORK V
TN1346536562OtherBLUE CROSS BLUE SHIELD TENNCARE SELECT
TN1346536562OtherBLUE CROSS BLUE SHIELD BLUE CARE
TN103I416085Medicare PIN