Provider Demographics
NPI:1497485817
Name:WALTERS, GAVIN JUDD (OD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:JUDD
Last Name:WALTERS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:6974 SIERRA MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5625
Mailing Address - Country:US
Mailing Address - Phone:719-651-6567
Mailing Address - Fax:
Practice Address - Street 1:6005 DELMONICO DR STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2264
Practice Address - Country:US
Practice Address - Phone:719-522-9393
Practice Address - Fax:719-532-1114
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COOPT.0003810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist