Provider Demographics
NPI:1275536849
Name:WALSH, DANIEL P (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:WALSH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:320 BROOKES DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2736
Mailing Address - Country:US
Mailing Address - Phone:314-726-5669
Mailing Address - Fax:314-726-5109
Practice Address - Street 1:7934 N LINDBERGH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3521
Practice Address - Country:US
Practice Address - Phone:314-921-2020
Practice Address - Fax:314-921-7954
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL565350002Medicare PIN
U76682Medicare UPIN