Provider Demographics
NPI:1003203084
Name:STEVEN WALSH OPTOMETRY
Entity Type:Organization
Organization Name:STEVEN WALSH OPTOMETRY
Other - Org Name:THE PATASKALA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-395-6998
Mailing Address - Street 1:180 E BROAD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7573
Mailing Address - Country:US
Mailing Address - Phone:740-927-3061
Mailing Address - Fax:
Practice Address - Street 1:180 E BROAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7573
Practice Address - Country:US
Practice Address - Phone:740-927-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10814862OtherCAQH
OHH301710Medicare PIN
OH10814862OtherCAQH
OHH303760Medicare PIN