Healthcare Provider Details

I. General information

NPI: 1619207305
Provider Name (Legal Business Name): WINCHESTER FAMILY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2010
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 E GREENVILLE AVE
WINCHESTER IN
47394-8441
US

IV. Provider business mailing address

882 E GREENVILLE AVE
WINCHESTER IN
47394-8441
US

V. Phone/Fax

Practice location:
  • Phone: 765-584-1320
  • Fax: 765-584-2317
Mailing address:
  • Phone: 765-584-1320
  • Fax: 765-584-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GAIL FRANCES STEWART
Title or Position: MEMBER
Credential: O.D.
Phone: 765-584-1320