Provider Demographics
NPI:1649586892
Name:WINTER OPTOMETRY LLC
Entity type:Organization
Organization Name:WINTER OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-477-0194
Mailing Address - Street 1:6810 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6304
Mailing Address - Country:US
Mailing Address - Phone:850-477-0194
Mailing Address - Fax:850-380-4332
Practice Address - Street 1:6810 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6304
Practice Address - Country:US
Practice Address - Phone:850-477-0194
Practice Address - Fax:850-380-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL2316OtherEYEMED
FL410017312OtherRAILROAD MEDICARE
FL64251OtherDAVIS VISION
FL44939OtherAVESIS
FL47093OtherSPECTERA
FL078855400Medicaid
FL078855400Medicaid
FL410017312OtherRAILROAD MEDICARE