Provider Demographics
NPI:1447616859
Name:WINSLADE, KATRINA (OD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:WINSLADE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BRADLEE RD APT 30
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3149
Mailing Address - Country:US
Mailing Address - Phone:617-678-9728
Mailing Address - Fax:
Practice Address - Street 1:939 SALEM ST UNIT 7
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1566
Practice Address - Country:US
Practice Address - Phone:978-374-8991
Practice Address - Fax:978-373-7852
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist