Provider Demographics
NPI:1629036991
Name:WINESETT, MARVIN ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:ALAN
Last Name:WINESETT
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 1:3398 HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-9024
Mailing Address - Country:US
Mailing Address - Phone:828-396-1919
Mailing Address - Fax:828-396-7014
Practice Address - Street 1:3398 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-9024
Practice Address - Country:US
Practice Address - Phone:828-396-1919
Practice Address - Fax:828-396-7014
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909554Medicaid
NC2466622DMedicare PIN