Provider Demographics
NPI:1831484245
Name:WINTERS, BRUCE (OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:WINTERS
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 1:617 AVENIDA SEVILLA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-4584
Mailing Address - Country:US
Mailing Address - Phone:949-636-0177
Mailing Address - Fax:
Practice Address - Street 1:617 AVENIDA SEVILLA
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-4584
Practice Address - Country:US
Practice Address - Phone:949-636-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5348T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist