Provider Demographics
NPI:1043407927
Name:WALSH OPTOMETRY, P.A.
Entity Type:Organization
Organization Name:WALSH OPTOMETRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-844-0938
Mailing Address - Street 1:P.O. BOX 80214
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27623-0214
Mailing Address - Country:US
Mailing Address - Phone:919-792-2999
Mailing Address - Fax:919-554-1406
Practice Address - Street 1:7330 OLD WAKE FOREST RD.
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3047
Practice Address - Country:US
Practice Address - Phone:919-792-2999
Practice Address - Fax:919-554-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19072OtherEYEMED
NC0900FOtherBCBS
NC890900FMedicaid
NC890900FMedicaid
NC2470519AMedicare PIN