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General NPI Number Information
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NPI Number | 1801858808
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Entity Type | Organization
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Legal Business Name | WINONA OPHTHALMOLOGY
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 62 E 4TH ST
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City | WINONA
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State | MN
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Zip | 55987-3508
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Country | US
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Telephone | 507-454-4523
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Fax | 507-454-0116
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Provider Business Mailing Address
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Address Line | 62 E 4TH ST
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City | WINONA
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State | MN
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Zip | 55987-3508
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Country | US
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Telephone | 507-454-4523
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Fax | 507-454-0116
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. WENDY SMITH SUZANNE SMITH
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Credential |
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Telephone | 507-454-4523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 20008
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License Number State | MN
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