Provider Demographics
NPI:1760453435
Name:WINBIGLER, TODD DONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DONALD
Last Name:WINBIGLER
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 1:939 W. BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706
Mailing Address - Country:US
Mailing Address - Phone:208-344-8758
Mailing Address - Fax:208-331-3379
Practice Address - Street 1:939 W. BEACON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-344-8758
Practice Address - Fax:208-331-3379
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1243380001OtherDMERC
IDV6630OtherBLUE CROSS
ID000010015349OtherBLUE SHIELD
ID002622500Medicaid
ID15915101Medicare PIN
ID002622500Medicaid
ID000010015349OtherBLUE SHIELD