Provider Demographics
NPI:1790754968
Name:DEWINTER, DANIEL J (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:DEWINTER
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-0547
Mailing Address - Country:US
Mailing Address - Phone:262-679-1420
Mailing Address - Fax:262-679-3810
Practice Address - Street 1:S75W17475 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9378
Practice Address - Country:US
Practice Address - Phone:262-679-1420
Practice Address - Fax:262-679-3810
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2423-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38589900Medicaid
WIMD0006951OtherDEA #
WIU-28619Medicare UPIN
WI38589900Medicaid
WI000087324Medicare PIN