Provider Demographics
NPI:1770801300
Name:WINELAND FAMILY EYECARE LLC
Entity type:Organization
Organization Name:WINELAND FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WINELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-452-3127
Mailing Address - Street 1:731 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4644
Mailing Address - Country:US
Mailing Address - Phone:920-452-3127
Mailing Address - Fax:920-457-6659
Practice Address - Street 1:731 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4644
Practice Address - Country:US
Practice Address - Phone:920-452-3127
Practice Address - Fax:920-457-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6395720001Medicare NSC