Provider Demographics
NPI:1467559625
Name:WINCHESTER EYE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:WINCHESTER EYE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-661-7762
Mailing Address - Street 1:525 AMHERST STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-667-5535
Mailing Address - Fax:540-667-5536
Practice Address - Street 1:525 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3881
Practice Address - Country:US
Practice Address - Phone:540-667-5535
Practice Address - Fax:540-667-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH707261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467559625Medicaid
VAP00421716OtherRAILROAD MEDICARE
VA306372OtherCARE FIRST BCBS
VA306372OtherANTHEM BCBS
VA192949774Medicare PIN