Basic Information
| Provider Information | |||||||||
| NPI: | 1114071644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINKE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ROBERT J WINKE 1418 S BALMORAL AVE | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601543637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088658266 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ROBERT J WINKE 5201 N HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606561803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736372020 | ||||||||
| FaxNumber: | 7737743581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT5047 | CA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | IL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0001684345 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER |