Healthcare Provider Details

I. General information

NPI: 1366339087
Provider Name (Legal Business Name): LAUREN IVANOSKI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 WINTERHAVEN LN
WINSTON SALEM NC
27103-6792
US

IV. Provider business mailing address

2341 WINTERHAVEN LN
WINSTON SALEM NC
27103-6792
US

V. Phone/Fax

Practice location:
  • Phone: 336-760-2020
  • Fax:
Mailing address:
  • Phone: 336-760-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2909
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.2544
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: