Provider Demographics
NPI:1033297395
Name:WALTHALL, JAMES H (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:WALTHALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:7002B LITTLE RIVER TPK
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3200
Mailing Address - Country:US
Mailing Address - Phone:703-256-2626
Mailing Address - Fax:703-354-3226
Practice Address - Street 1:7002B LITTLE RIVER TPK
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3200
Practice Address - Country:US
Practice Address - Phone:703-256-2626
Practice Address - Fax:703-354-3226
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT30938Medicare UPIN
VA148489Medicare PIN