Provider Demographics
NPI:1790268134
Name:WINTERS, RAE A (OD)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:A
Last Name:WINTERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7982 FAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-9581
Mailing Address - Country:US
Mailing Address - Phone:812-528-1737
Mailing Address - Fax:
Practice Address - Street 1:1537 S SCATTERFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5783
Practice Address - Country:US
Practice Address - Phone:765-374-6372
Practice Address - Fax:765-649-4040
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist