Provider Demographics
NPI:1093035487
Name:KUNZ, WALTER BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:BENJAMIN
Last Name:KUNZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 OAK ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7701
Mailing Address - Country:US
Mailing Address - Phone:541-687-1927
Mailing Address - Fax:
Practice Address - Street 1:1550 OAK ST
Practice Address - Street 2:SUITE 7
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7701
Practice Address - Country:US
Practice Address - Phone:541-687-1927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171620207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500684244Medicaid
OR500684244Medicaid