Provider Demographics
NPI:1083608459
Name:CHOATE, WALTER L (OD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:L
Last Name:CHOATE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:306 NORTHCREEK BLVD
Mailing Address - Street 2:STE.101
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2086
Mailing Address - Country:US
Mailing Address - Phone:615-851-7575
Mailing Address - Fax:615-851-8725
Practice Address - Street 1:306 NORTHCREEK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2089
Practice Address - Country:US
Practice Address - Phone:615-851-7575
Practice Address - Fax:615-851-8725
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNOD0000000716152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0672520001OtherD MERC
TN2240170OtherUNITED HEALTHCARE TN
TN3594847Medicaid
TNT-61213OtherHEALH SPRING TN
TN0028006OtherBLUECROSS BLUESHIELD TN
TN969368OtherAETNA
TN410040172OtherMEDICARE RAILROAD
TN969368OtherAETNA
TN2240170OtherUNITED HEALTHCARE TN
TNT-61213Medicare UPIN