Healthcare Provider Details

I. General information

NPI: 1598396244
Provider Name (Legal Business Name): WINK EYECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 TURNER RD SE
SALEM OR
97302-2003
US

IV. Provider business mailing address

17252 SW 136TH AVE
KING CITY OR
97224-2224
US

V. Phone/Fax

Practice location:
  • Phone: 503-312-6464
  • Fax:
Mailing address:
  • Phone: 503-312-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANN WOODS
Title or Position: OWNER
Credential: OD
Phone: 503-312-6464