Provider Demographics
NPI:1316972649
Name:WINSTON, JEFFREY VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:VICTOR
Last Name:WINSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 N HARBOR BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4107
Mailing Address - Country:US
Mailing Address - Phone:714-888-2080
Mailing Address - Fax:714-888-2099
Practice Address - Street 1:1400 N HARBOR BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4107
Practice Address - Country:US
Practice Address - Phone:714-888-2080
Practice Address - Fax:714-888-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49373207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G493730Medicaid
CA00G493730Medicaid
WG49373GMedicare ID - Type UnspecifiedMEDICARE NUMBER