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General NPI Number Information
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NPI Number | 1225209109
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Entity Type | Organization
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Legal Business Name | LYNDA D. WINTER
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 622 LINCOLN CTR
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City | STOCKTON
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State | CA
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Zip | 95207-2640
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Country | US
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Telephone | 209-955-7570
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Fax | 209-955-7580
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Provider Business Mailing Address
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Address Line | 622 LINCOLN CTR
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City | STOCKTON
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State | CA
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Zip | 95207-2640
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Country | US
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Telephone | 209-955-7570
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Fax | 209-955-7580
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Authorized Official
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Title or Position | OWNER/ OPTICIAN
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Name | MRS. LYNDA DIANE WINTER
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Credential | ABOC
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Telephone | 209-955-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | D4469
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License Number State | CA
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