Provider Demographics
NPI:1225136245
Name:WALSH, LAURA C (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:WALSH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 S CLINTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4220
Mailing Address - Country:US
Mailing Address - Phone:215-345-5144
Mailing Address - Fax:215-345-5846
Practice Address - Street 1:10 S CLINTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4220
Practice Address - Country:US
Practice Address - Phone:215-345-5144
Practice Address - Fax:215-345-5846
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1376603324OtherNPI - GROUP
PA109873Medicare UPIN