Provider Demographics
NPI:1437284445
Name:WINSTON EYE ASSOCIATES OD PA
Entity Type:Organization
Organization Name:WINSTON EYE ASSOCIATES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-595-4588
Mailing Address - Street 1:2741 OLD HOLLOW RD. HWY 66
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051
Mailing Address - Country:US
Mailing Address - Phone:336-595-4588
Mailing Address - Fax:336-595-6277
Practice Address - Street 1:2741 OLD HOLLOW RD. HWY 66
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051
Practice Address - Country:US
Practice Address - Phone:336-595-4588
Practice Address - Fax:336-595-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09958OtherBLUECROSS
NC8909958Medicaid
NC410034997OtherRR MCR #
NC2467300AMedicare PIN
NC09958OtherBLUECROSS