Provider Demographics
NPI:1891975231
Name:DR. ROGER C. WINEINGER OPTOMETRIC PA
Entity Type:Organization
Organization Name:DR. ROGER C. WINEINGER OPTOMETRIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WINEINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-631-0090
Mailing Address - Street 1:7505 QUIVIRA RD.
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1094-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK250000Medicare PIN