Provider Demographics
NPI:1598731341
Name:WALSH, EILEEN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:WALSH
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:P.O. BOX 80214
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27623-0214
Mailing Address - Country:US
Mailing Address - Phone:919-792-2999
Mailing Address - Fax:919-554-1406
Practice Address - Street 1:7330 OLD WAKE FOREST RD.
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3047
Practice Address - Country:US
Practice Address - Phone:919-792-2999
Practice Address - Fax:919-554-1406
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890900FMedicaid
U93198Medicare UPIN
NC890900FMedicaid