Provider Demographics
NPI:1790861250
Name:WINEINGER, ROGER CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHARLES
Last Name:WINEINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7505 QUIVIRA RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-3501
Mailing Address - Country:US
Mailing Address - Phone:913-631-0090
Mailing Address - Fax:913-631-7416
Practice Address - Street 1:7505 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-3501
Practice Address - Country:US
Practice Address - Phone:913-631-0090
Practice Address - Fax:913-631-7416
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1094-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK251984Medicare PIN
KSX51581Medicare UPIN