Provider Demographics
NPI:1871854794
Name:WALTON, MEGAN (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 CHARLIE HALL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6066
Mailing Address - Country:US
Mailing Address - Phone:843-722-2010
Mailing Address - Fax:843-723-3914
Practice Address - Street 1:2060 CHARLIE HALL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6066
Practice Address - Country:US
Practice Address - Phone:843-722-2010
Practice Address - Fax:843-723-3914
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003726A152W00000X
SCOPT.1877 OPT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9628Medicaid