Provider Demographics
NPI:1205868064
Name:WALTERS OPTOMETRIC CENTER, P. C.
Entity Type:Organization
Organization Name:WALTERS OPTOMETRIC CENTER, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-826-2222
Mailing Address - Street 1:538 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1911
Mailing Address - Country:US
Mailing Address - Phone:610-826-2222
Mailing Address - Fax:
Practice Address - Street 1:538 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1911
Practice Address - Country:US
Practice Address - Phone:610-826-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0070317700002Medicaid
PA0535676OtherAETNA
PA40976OtherDAVIS VISION
PA396830OtherNATIONAL VISION ADMINISTR
PAPA07241OtherVISION BENEFITS OF AMERIC
PA080827OtherFIRST PRIORITY HEALTH
PA6108262222OtherVISION SERVICE PLAN
PA0535676OtherAETNA
PA673383Medicare ID - Type UnspecifiedPART B
PAPA07241OtherVISION BENEFITS OF AMERIC