Provider Demographics
NPI:1700851631
Name:WALBY, MICHAEL ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:WALBY
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 1:404 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2105
Mailing Address - Country:US
Mailing Address - Phone:850-584-2200
Mailing Address - Fax:888-429-8421
Practice Address - Street 1:404 E ASH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2105
Practice Address - Country:US
Practice Address - Phone:850-584-2200
Practice Address - Fax:888-429-8421
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP1063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19142OtherBLUE CROSS BLUE SHIELD
FL084889100Medicaid
FL084889100Medicaid
T84084Medicare UPIN