Provider Demographics
NPI:1417069196
Name:WALZ VISION PA
Entity Type:Organization
Organization Name:WALZ VISION PA
Other - Org Name:BAY AREA VISION & CONTACT LENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-993-7778
Mailing Address - Street 1:5425 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 119-B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5301
Mailing Address - Country:US
Mailing Address - Phone:361-993-7778
Mailing Address - Fax:361-993-7846
Practice Address - Street 1:5425 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 119-B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5301
Practice Address - Country:US
Practice Address - Phone:361-993-7778
Practice Address - Fax:361-993-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX4039TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E79WMedicare PIN