Provider Demographics
NPI:1659585925
Name:WYNNE, JOEL B (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:B
Last Name:WYNNE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:80 S TUNNEL RD
Mailing Address - Street 2:#100
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2252
Mailing Address - Country:US
Mailing Address - Phone:828-298-2022
Mailing Address - Fax:828-298-3908
Practice Address - Street 1:80 S TUNNEL RD
Practice Address - Street 2:#100
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2252
Practice Address - Country:US
Practice Address - Phone:828-298-2022
Practice Address - Fax:828-298-3908
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2017-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC1679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2470436AOtherPTAN
NC2470436AOtherPTAN