Provider Demographics
NPI:1710025507
Name:WINKEL, LAURA W (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:W
Last Name:WINKEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:WYNECOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3221 W KENNEWICK AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2919
Mailing Address - Country:US
Mailing Address - Phone:509-783-3986
Mailing Address - Fax:509-736-3918
Practice Address - Street 1:3221 W KENNEWICK AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2919
Practice Address - Country:US
Practice Address - Phone:509-783-3986
Practice Address - Fax:509-736-3918
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001873TX152W00000X, 152WC0802X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017014Medicaid
WA912017947OtherFEDERAL TAX ID
WA912017947OtherFEDERAL TAX ID
WAG000304067Medicare ID - Type Unspecified