MEDICARE: DANIELLE VAN WINKLE OPTOMETRY TECH

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	156FX1202X	Optometric Technician

General Provider Information

NPI Number	:	1720449473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE VAN WINKLE OPTOMETRY TECH

Provider Business Mailing Address
First Line	:	BLDG 301 ANDREWS AVE
Second Line	:	LYSTER ARMY HEALTH CLINIC
City	:	FORT RUCKER
State	:	AL
Zip	:	36362-5333
Country	:	US
Telephone Number	:	334-255-7185
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 301 ANDREWS AVE
Second Line	:	LYSTER ARMY HEALTH CLINIC
City	:	FORT RUCKER
State	:	AL
Zip	:	36362-5333
Country	:	US
Telephone Number	:	334-255-7185
Fax Number	:

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

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	03/09/2016

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