Provider Demographics
NPI:1922358100
Name:WINSLOW RETINA & VISION CENTER, INC.
Entity Type:Organization
Organization Name:WINSLOW RETINA & VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-622-5650
Mailing Address - Street 1:1649 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4160
Mailing Address - Country:US
Mailing Address - Phone:321-622-5650
Mailing Address - Fax:
Practice Address - Street 1:1649 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4160
Practice Address - Country:US
Practice Address - Phone:321-622-5650
Practice Address - Fax:321-622-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91061207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H62352Medicare UPIN