Provider Demographics
NPI:1750373411
Name:WINWARD, RICK W (OD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:W
Last Name:WINWARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 N 540 E
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3773
Mailing Address - Country:US
Mailing Address - Phone:801-491-9864
Mailing Address - Fax:
Practice Address - Street 1:1353 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7701
Practice Address - Country:US
Practice Address - Phone:801-225-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4944080-9934152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005750201Medicare ID - Type UnspecifiedSPRINGVILLE LOCATION
UTU85792Medicare UPIN
UT005750101Medicare ID - Type UnspecifiedPROVO LOCATION