Provider Demographics
NPI:1093870867
Name:WALBORN, BRIAN T (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:WALBORN
Suffix:
Gender:M
Credentials:OD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 ESKENAZI AVENUE
Mailing Address - Street 2:FIFTH THIRD BANK BLDG., 5TH FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-3851
Mailing Address - Fax:317-880-0403
Practice Address - Street 1:3840 N SHERMAN DR
Practice Address - Street 2:ESKENAZI HEALTH CENTER FOREST MANO
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4462
Practice Address - Country:US
Practice Address - Phone:317-541-3400
Practice Address - Fax:317-541-3444
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18003257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201307120Medicaid
IN940510932Medicare PIN
IN201307120Medicaid
ININ1768249Medicare PIN
IN92672Medicare UPIN