Provider Demographics
NPI:1801907670
Name:WINTJEN, COURTNEY L (OD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:L
Last Name:WINTJEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:L
Other - Last Name:VANNOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1426 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6563
Mailing Address - Country:US
Mailing Address - Phone:417-887-7151
Mailing Address - Fax:417-887-7153
Practice Address - Street 1:1426 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6563
Practice Address - Country:US
Practice Address - Phone:417-887-7151
Practice Address - Fax:417-887-7153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist