MEDICARE: WINSTON EYE ASSOCIATES OD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	09985	OTHER	NC	BLUECROSS
3	410034342	OTHER	NC	RR MCR#

General Provider Information

NPI Number	:	1699810986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINSTON EYE ASSOCIATES OD PA

Provider Business Mailing Address
First Line	:	2630 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5655
Country	:	US
Telephone Number	:	336-785-3486
Fax Number	:	336-785-3002

Provider Business Practice Location Address
First Line	:	2630 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5655
Country	:	US
Telephone Number	:	336-785-3486
Fax Number	:	336-785-3002

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. JOHN M. BURKE
Credential	:	O.D.
Telephone Number	:	336-785-3486

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/21/2022

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