Provider Demographics
NPI:1144240557
Name:APPANAITIS, WALTER ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ALEXANDER
Last Name:APPANAITIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5305 ROBINHOOD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-9820
Mailing Address - Country:US
Mailing Address - Phone:336-924-9121
Mailing Address - Fax:336-924-6215
Practice Address - Street 1:5305 ROBINHOOD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-9820
Practice Address - Country:US
Practice Address - Phone:336-924-9121
Practice Address - Fax:336-924-6215
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC090914WMedicaid
NC090914WMedicaid
NC2470793BMedicare PIN
NC2470793CMedicare PIN