E Wingo & P Colchiski PTR

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

ME0028326 Issued in FL

Legal business name

E WINGO & P COLCHISKI PTR

Practice address

2437 E Fort King St
Ocala, FL 34471-2558

Phone

(352) 629-2422

Fax

(352) 732-0177

NPI assigned

Jan 12, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Penelope Colchiski Wingo

Title

Coowner-Manager

Phone

(352) 629-2422

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• EyeCare Boutique Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

E Wingo P Colchiski PTR2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• E Wingo & P Colchiski PTR

  • Eyewear Supplier
  • Ocala, FL
  • NPI 1043616527
  NPD tax ID

Locations

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1629128475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2437 E FORT KING ST",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344712558",
            "telephone_number": "352-629-2422",
            "fax_number": "352-732-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2437 E FORT KING ST",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344712558",
            "telephone_number": "352-629-2422",
            "fax_number": "352-732-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E WINGO & P COLCHISKI PTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "WINGO",
        "authorized_official_first_name": "PENELOPE",
        "authorized_official_middle_name": "COLCHISKI",
        "authorized_official_title_or_position": "COOWNER-MANAGER",
        "authorized_official_telephone_number": "352-629-2422",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "FL",
            "license": "ME0028326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "057222500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EyeCare Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Ocala, FL
• Providers in Ocala, FL by specialty
• Eyewear Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.