Provider Demographics
NPI:1720458540
Name:LORRAINE MARY WINGER, O.D.,P.C.
Entity Type:Organization
Organization Name:LORRAINE MARY WINGER, O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:WINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-382-4756
Mailing Address - Street 1:822 NW WALL ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2715
Mailing Address - Country:US
Mailing Address - Phone:541-382-4756
Mailing Address - Fax:541-382-4455
Practice Address - Street 1:822 NW WALL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2715
Practice Address - Country:US
Practice Address - Phone:541-382-4756
Practice Address - Fax:541-382-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1833-AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285700526OtherINDIVIDUAL NPI