Provider Demographics
NPI:1598769093
Name:WALTERS, KIMBERLEY DAWN (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:DAWN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-0564
Mailing Address - Country:US
Mailing Address - Phone:828-645-0061
Mailing Address - Fax:828-645-0602
Practice Address - Street 1:49 N BUNCOMBE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9608
Practice Address - Country:US
Practice Address - Phone:828-645-0061
Practice Address - Fax:828-645-0602
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09003OtherBCBS OF NC
NC7909003Medicaid
NC09003OtherBCBS OF NC
NC2471040AMedicare ID - Type Unspecified