Healthcare Provider Details

I. General information

NPI: 1477687135
Provider Name (Legal Business Name): JEFFREY V. WINSTON, MD A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N HARBOR BLVD STE 101
FULLERTON CA
92835-4107
US

IV. Provider business mailing address

1400 N HARBOR BLVD STE 101
FULLERTON CA
92835-4107
US

V. Phone/Fax

Practice location:
  • Phone: 714-888-2080
  • Fax: 714-888-2099
Mailing address:
  • Phone: 714-888-2080
  • Fax: 714-888-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8786T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12411T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9514T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA91820
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG49373
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY VICTOR WINSTON
Title or Position: OWNER
Credential: M.D.
Phone: 714-888-2080