Individual
DR. JEFFREY DAVID WINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2826 E BASELINE RD STE 101, MESA, AZ 85204-7282
(480) 626-8925
(480) 704-4036
Mailing address
2826 E BASELINE RD STE 101, MESA, AZ 85204-7282
(480) 626-8925
(480) 704-4036
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1544
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145725
—
AZ
Enumeration date
10/04/2006
Last updated
06/14/2022
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