Provider Demographics
NPI:1215092804
Name:DAVID W WINELAND
Entity type:Organization
Organization Name:DAVID W WINELAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER OF GROUP PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WINELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-477-2504
Mailing Address - Street 1:1180 N COURT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1397
Mailing Address - Country:US
Mailing Address - Phone:740-477-2504
Mailing Address - Fax:740-477-1987
Practice Address - Street 1:1180 N COURT ST
Practice Address - Street 2:SUITE F
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1397
Practice Address - Country:US
Practice Address - Phone:740-477-2504
Practice Address - Fax:740-477-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3755T701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003194028OtherNPI KLABUNDY
1609962299OtherNPI
9240901OtherMEDICARE GROUP #
OH0291830001OtherDMERC
1962659995OtherNPI EDER
1962659995OtherNPI EDER
OH0291830001OtherDMERC
OH0838575Medicare PIN
1609962299OtherNPI
OH0572963Medicare PIN
OH9240901Medicare PIN