Healthcare Provider Details

I. General information

NPI: 1326691437
Provider Name (Legal Business Name): JAMES E WINNICK OD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 CALIFORNIA AVE
OAKDALE CA
95361-2946
US

IV. Provider business mailing address

141 CALIFORNIA AVE
OAKDALE CA
95361-2946
US

V. Phone/Fax

Practice location:
  • Phone: 209-847-3051
  • Fax: 209-847-1405
Mailing address:
  • Phone: 209-847-3051
  • Fax: 209-847-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: YVONNE URQUIDEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-847-3051