Provider Demographics
NPI:1609878990
Name:EGENMAIER, WALTER H (OD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:H
Last Name:EGENMAIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NW 1ST ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1259
Mailing Address - Country:US
Mailing Address - Phone:812-426-2020
Mailing Address - Fax:812-426-2828
Practice Address - Street 1:101 NW 1ST ST
Practice Address - Street 2:SUITE 112
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1259
Practice Address - Country:US
Practice Address - Phone:812-426-2020
Practice Address - Fax:812-426-2828
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002611152W00000X
KY1000DT152W00000X
GA1235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4544563OtherAETNA
IN87793OtherANTHEM
IN100377200Medicaid
IN839180OtherMEDICARE
IN410021835OtherPALMENTO GBA
KY77340404Medicaid
IN4544563OtherAETNA
IN87793OtherANTHEM