Provider Demographics
NPI:1538279328
Name:WALTHER, GREGORY CARL (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CARL
Last Name:WALTHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17804 DIXONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-9311
Mailing Address - Country:US
Mailing Address - Phone:541-229-0992
Mailing Address - Fax:541-957-8549
Practice Address - Street 1:2125 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1693
Practice Address - Country:US
Practice Address - Phone:541-957-8537
Practice Address - Fax:541-957-8549
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1368ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist