Provider Demographics
NPI:1851538946
Name:SEAN G. WALTON LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:SEAN G. WALTON LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-443-0301
Mailing Address - Street 1:3400 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3922
Mailing Address - Country:US
Mailing Address - Phone:201-865-8660
Mailing Address - Fax:201-865-0971
Practice Address - Street 1:3400 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3922
Practice Address - Country:US
Practice Address - Phone:201-865-8660
Practice Address - Fax:201-865-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00616200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty