Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18001464 | IN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 18001464 | IN |
N | 152WP0200X | Pediatric Optomitrist | 18001464 | IN |
N | 152WS0006X | Sports Vision | 18001464 | IN |
N | 152WX0102X | Occupational Vision | 18001464 | IN |
NPI | 1063499978 |
---|---|
Provider Name | James E Van Winkle |
First Address | Bluffton, IN 46714-0374 |
Second Address | Bluffton, IN 46714-9007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200011590A | (05) | IN |
352144351 | BLUFFTON FAMILY EYE CARE (01) | IN |