Provider Demographics
NPI:1821295023
Name:WINGLER, SHANDELL
Entity Type:Individual
Prefix:MS
First Name:SHANDELL
Middle Name:
Last Name:WINGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5297
Mailing Address - Country:US
Mailing Address - Phone:541-772-2895
Mailing Address - Fax:
Practice Address - Street 1:2352 POPLAR DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5297
Practice Address - Country:US
Practice Address - Phone:541-772-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician