MEDICARE: JEFFREY P WINICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G46812	CA
2	207W00000X	Ophthalmology Physician	50258-020	WI
3	207W00000X	Ophthalmology Physician	036120884	IL
4	207W00000X	Ophthalmology Physician	2008014399	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285637652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY P WINICK M.D.

Provider Business Mailing Address
First Line	:	1165 DALLAS RD
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3680
Country	:	US
Telephone Number	:	559-573-2845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 DALLAS RD
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3680
Country	:	US
Telephone Number	:	559-573-2845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/12/2016

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