Provider Demographics
NPI:1609852664
Name:WALTERS, THOMAS RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RICHARD
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4203
Mailing Address - Country:US
Mailing Address - Phone:512-327-7000
Mailing Address - Fax:512-314-1662
Practice Address - Street 1:5717 BALCONES DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-327-7000
Practice Address - Fax:512-314-1662
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3889207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4111260OtherAETNA
TX89M673OtherBLUE CROSS BLUE SHIELD
TX911397OtherBLOCK VISION
TX2227412OtherBLUELINK
SC180024142Medicare PIN
VP12819OtherGE WELLNESS
130358101OtherFIRST CARE
B27412Medicare UPIN
32951-000OtherDAVIS VISION
TX126276801Medicaid
TX3889OtherEYEMED
55343-000OtherDAVIS VISION
TX88Y380Medicare PIN
SC180005734Medicare PIN
TX10026682OtherAMERIGROUP
TX126276802Medicaid
TX89M673Medicare PIN