Provider Demographics
NPI:1689410565
Name:WINDLER, JENNIFER DIANA (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANA
Last Name:WINDLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2154
Mailing Address - Country:US
Mailing Address - Phone:508-723-4991
Mailing Address - Fax:
Practice Address - Street 1:850 E VALLEY RD
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-7600
Practice Address - Country:US
Practice Address - Phone:970-718-0007
Practice Address - Fax:970-279-8102
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5714152W00000X
COOPT.0004049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist