Provider Demographics
NPI:1013032572
Name:WALSH, STEVEN DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DAVID
Last Name:WALSH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:WALSH
Other - Last Name:OPTOMETRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:153 TRAIL EAST RD
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9652
Mailing Address - Country:US
Mailing Address - Phone:614-863-9104
Mailing Address - Fax:614-863-9379
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:614-395-6998
Practice Address - Fax:740-927-7042
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHO129462Medicaid
OHO129462Medicaid
OHH301710Medicare PIN