Provider Demographics
NPI:1396052163
Name:WINCHELL, TARRA JUSTINE (OD)
Entity type:Individual
Prefix:DR
First Name:TARRA
Middle Name:JUSTINE
Last Name:WINCHELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 GENERAL MAXWELL CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2452
Mailing Address - Country:US
Mailing Address - Phone:302-668-8750
Mailing Address - Fax:
Practice Address - Street 1:19 HAINES ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4610
Practice Address - Country:US
Practice Address - Phone:302-239-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001348152W00000X
PAOEG002416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist