Provider Demographics
NPI:1598702185
Name:WINTERS, RYAN W (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:W
Last Name:WINTERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 BAY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-3051
Mailing Address - Country:US
Mailing Address - Phone:518-792-3304
Mailing Address - Fax:518-792-3307
Practice Address - Street 1:357 BAY RD STE 6
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3051
Practice Address - Country:US
Practice Address - Phone:518-792-3304
Practice Address - Fax:518-792-3307
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598702185OtherRAILROAD
NYRA2704Medicare ID - Type Unspecified
V00688Medicare UPIN
NY1033640001Medicare NSC