Provider Demographics
NPI:1669457255
Name:SCASE, WALTER W (OD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:W
Last Name:SCASE
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 1:1522 S 700 W
Mailing Address - Street 2:
Mailing Address - City:SWAYZEE
Mailing Address - State:IN
Mailing Address - Zip Code:46986
Mailing Address - Country:US
Mailing Address - Phone:765-384-7830
Mailing Address - Fax:
Practice Address - Street 1:3240 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-3967
Practice Address - Country:US
Practice Address - Phone:765-662-3936
Practice Address - Fax:765-662-3978
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002915B152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN296630Medicare ID - Type Unspecified
U69540Medicare UPIN