Provider Demographics
NPI:1609154608
Name:WALTERS, EMILY L (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1601 W 41ST ST
Mailing Address - Street 2:PO BOX 303
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6371
Mailing Address - Country:US
Mailing Address - Phone:605-338-3928
Mailing Address - Fax:605-334-4915
Practice Address - Street 1:6601 S MINNESOTA AVE STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-336-6294
Practice Address - Fax:605-336-0266
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD675152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist