Provider Demographics
NPI:1558415737
Name:WINDSOR, LAURA K (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:K
Last Name:WINDSOR
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:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-0166
Mailing Address - Country:US
Mailing Address - Phone:765-348-2020
Mailing Address - Fax:765-348-2503
Practice Address - Street 1:315 HUGGINS DR
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-8999
Practice Address - Country:US
Practice Address - Phone:765-348-2020
Practice Address - Fax:765-348-2503
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003128A152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410045980OtherRRMC
IN200329030Medicaid
INU85553Medicare UPIN
IN070720FMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID
IN200329030Medicaid