Provider Demographics
NPI:1508135500
Name:GEORGE R. WALTERS, M.D., P.A.
Entity Type:Organization
Organization Name:GEORGE R. WALTERS, M.D., P.A.
Other - Org Name:CUSTOM LASIK AND CATARACT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-235-3937
Mailing Address - Street 1:8300 OLD MCGREGOR RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3600
Mailing Address - Country:US
Mailing Address - Phone:254-235-3937
Mailing Address - Fax:254-235-1517
Practice Address - Street 1:8300 OLD MCGREGOR RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3600
Practice Address - Country:US
Practice Address - Phone:254-235-3937
Practice Address - Fax:254-235-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4749207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23145Medicare UPIN