Provider Demographics
NPI:1013702521
Name:WINDER, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:WINDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S WHITE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7849
Mailing Address - Country:US
Mailing Address - Phone:928-532-1547
Mailing Address - Fax:928-532-1549
Practice Address - Street 1:5401 S WHITE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7849
Practice Address - Country:US
Practice Address - Phone:928-532-1547
Practice Address - Fax:928-532-1549
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLDO-003195156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician