Provider Demographics
NPI:1366648354
Name:WINTER, LYNDA DIANE (ABOC)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:DIANE
Last Name:WINTER
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 LINCOLN CENTER
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-2640
Mailing Address - Country:US
Mailing Address - Phone:209-955-7570
Mailing Address - Fax:209-955-7580
Practice Address - Street 1:622 LINCOLN CTR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2640
Practice Address - Country:US
Practice Address - Phone:209-955-7570
Practice Address - Fax:209-955-7580
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD4469156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51625Medicare UPIN
CA0311710002Medicare NSC