Provider Demographics
NPI:1134189830
Name:WINTERS, KAREN ANN (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:WINTERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1637
Mailing Address - Country:US
Mailing Address - Phone:315-425-0373
Mailing Address - Fax:315-425-0374
Practice Address - Street 1:720 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1637
Practice Address - Country:US
Practice Address - Phone:315-425-0373
Practice Address - Fax:315-425-0374
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004959-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53564BMedicare ID - Type Unspecified