Provider Demographics
NPI:1578848297
Name:WALDEN EYE CARE, LLC
Entity Type:Organization
Organization Name:WALDEN EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-489-4463
Mailing Address - Street 1:50 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-1223
Mailing Address - Country:US
Mailing Address - Phone:765-489-4463
Mailing Address - Fax:765-489-5897
Practice Address - Street 1:50 N PERRY ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-1223
Practice Address - Country:US
Practice Address - Phone:765-489-4463
Practice Address - Fax:765-489-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003616A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty