Provider Demographics
NPI:1538223417
Name:DAVID W WINELAND
Entity type:Organization
Organization Name:DAVID W WINELAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER OF GROUP PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WINELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-392-4000
Mailing Address - Street 1:110 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2628
Mailing Address - Country:US
Mailing Address - Phone:740-392-4000
Mailing Address - Fax:740-392-6379
Practice Address - Street 1:110 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2628
Practice Address - Country:US
Practice Address - Phone:740-392-4000
Practice Address - Fax:740-392-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3755T701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609962299OtherNPI
1962659995OtherNPI
OH687261Medicaid
OH0560610Medicaid
1003194028OtherNPI
9240821OtherMEDICARE GROUP
OH0291830001Medicare NSC
0572962Medicare PIN
1962659995OtherNPI
OH9240821Medicare PIN
9240821OtherMEDICARE GROUP
OH0560610Medicaid