Provider Demographics
NPI:1295738318
Name:FIRTH, WINONA J (OD)
Entity type:Individual
Prefix:DR
First Name:WINONA
Middle Name:J
Last Name:FIRTH
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:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-0004
Mailing Address - Country:US
Mailing Address - Phone:541-746-8401
Mailing Address - Fax:541-746-8402
Practice Address - Street 1:840 A ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4710
Practice Address - Country:US
Practice Address - Phone:541-746-8401
Practice Address - Fax:541-746-8402
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2194ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR020839Medicaid
OR011342000OtherBLUE CROSS BLUE SHIELD
OR02805-01OtherPACIFIC SOURCE
OR800678OtherPROVIDENCE
OR020839Medicaid
OR800678OtherPROVIDENCE