Provider Demographics
NPI:1891425930
Name:WALTON, VANCE R (CFO)
Entity Type:Individual
Prefix:MR
First Name:VANCE
Middle Name:R
Last Name:WALTON
Suffix:
Gender:M
Credentials:CFO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2301 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4309
Mailing Address - Country:US
Mailing Address - Phone:336-333-9081
Mailing Address - Fax:336-333-9083
Practice Address - Street 1:2301 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4309
Practice Address - Country:US
Practice Address - Phone:336-333-9081
Practice Address - Fax:336-333-9083
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04891225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter