Provider Demographics
NPI:1699810986
Name:WINSTON EYE ASSOCIATES OD PA
Entity Type:Organization
Organization Name:WINSTON EYE ASSOCIATES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-785-3486
Mailing Address - Street 1:2630 PETERS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-5655
Mailing Address - Country:US
Mailing Address - Phone:336-785-3486
Mailing Address - Fax:336-785-3002
Practice Address - Street 1:2630 PETERS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5655
Practice Address - Country:US
Practice Address - Phone:336-785-3486
Practice Address - Fax:336-785-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909985Medicaid
NC09985OtherBLUECROSS
NC410034342OtherRR MCR#
NC09985OtherBLUECROSS
NC2467300Medicare PIN