Provider Demographics
NPI:1609962299
Name:WINELAND, DAVE WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVE
Middle Name:WILLIAM
Last Name:WINELAND
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 1:110 COSHOCTON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2628
Mailing Address - Country:US
Mailing Address - Phone:740-392-4000
Mailing Address - Fax:740-392-4000
Practice Address - Street 1:110 COSHOCTON AVE STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2628
Practice Address - Country:US
Practice Address - Phone:740-392-4000
Practice Address - Fax:740-392-6379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3755-T701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1215092804OtherNPI GROUP CIR
1538223417OtherNPI GROUP MTV
9240821OtherPTAN MTV
OH1609962299OtherNPI INDIVIDUAL
9240821OtherPTAN MTV
OHT48248Medicare UPIN
OH0572962Medicare PIN
1538223417OtherNPI GROUP MTV
OH1609962299OtherNPI INDIVIDUAL
OH9240901Medicare PIN