Provider Demographics
NPI:1932606100
Name:WINCHESTER EYE CLINIC, PLLC.
Entity Type:Organization
Organization Name:WINCHESTER EYE CLINIC, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-967-2230
Mailing Address - Street 1:183 HOSPITAL RD STE H
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-6207
Mailing Address - Country:US
Mailing Address - Phone:931-967-2230
Mailing Address - Fax:931-967-9622
Practice Address - Street 1:183 HOSPITAL RD STE H
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-6207
Practice Address - Country:US
Practice Address - Phone:931-967-2230
Practice Address - Fax:931-967-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002752152W00000X
TN0000002572152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty