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General NPI Number Information
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NPI Number | 1629128475
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Entity Type | Organization
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Legal Business Name | E WINGO & P COLCHISKI PTR
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2437 E FORT KING ST
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City | OCALA
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State | FL
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Zip | 34471-2558
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Country | US
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Telephone | 352-629-2422
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Fax | 352-732-0177
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Provider Business Mailing Address
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Address Line | 2437 E FORT KING ST
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City | OCALA
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State | FL
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Zip | 34471-2558
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Country | US
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Telephone | 352-629-2422
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Fax | 352-732-0177
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Authorized Official
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Title or Position | COOWNER-MANAGER
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Name | MRS. PENELOPE COLCHISKI WINGO
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Credential |
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Telephone | 352-629-2422
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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 | ME0028326
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License Number State | FL
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