Provider Demographics
NPI:1598396244
Name:WINK EYECARE, INC.
Entity Type:Organization
Organization Name:WINK EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-312-6464
Mailing Address - Street 1:17252 SW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2224
Mailing Address - Country:US
Mailing Address - Phone:503-312-6464
Mailing Address - Fax:
Practice Address - Street 1:1940 TURNER RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2003
Practice Address - Country:US
Practice Address - Phone:503-312-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty