Provider Demographics
NPI:1801858808
Name:WINONA OPHTHALMOLOGY
Entity Type:Organization
Organization Name:WINONA OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY SMITH
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-454-4523
Mailing Address - Street 1:62 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3508
Mailing Address - Country:US
Mailing Address - Phone:507-454-4523
Mailing Address - Fax:507-454-0116
Practice Address - Street 1:62 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3508
Practice Address - Country:US
Practice Address - Phone:507-454-4523
Practice Address - Fax:507-454-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20008173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty