Dejuan Lamont Wynn, OPTICIAN

Primary specialty

OpticianTaxonomy code 156FX1800X

License

164759 Issued in NY

Practice address

167 Lenox Ave
New York, NY 10026-1320

Phone

(212) 222-6100

Fax

(212) 222-6606

NPI assigned

Nov 24, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wynn Optics Corp

  • Optician
  • New York, NY
  • NPI 1366584559
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195862400000",
    "number": "1184805764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 LENOX AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100261320",
            "telephone_number": "212-222-6100",
            "fax_number": "212-222-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 LENOX AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100261320",
            "telephone_number": "212-222-6100",
            "fax_number": "212-222-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "DEJUAN",
        "middle_name": "LAMONT",
        "name_prefix": "Mr.",
        "credential": "OPTICIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-24",
        "last_updated": "2007-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "164759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wynn Optics Corp
• Wynn Optics II Corp
• Alyssa Wynn, LCSW
• Cymone Wynn
• Danielle Wynn
• Eleanor Grace Wynn, MHC-LP
• Jill J. Wynn, LCSW
• Julia Wynn, MS, CGC
• Kristin Wynn, LCSW
• Laura Wynn, MSW

• Optician in New York, NY
• Providers in New York, NY by specialty
• Optician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.