Provider Demographics
NPI:1942591839
Name:WALTON, OTIS BENNETT IV (MD)
Entity Type:Individual
Prefix:
First Name:OTIS
Middle Name:BENNETT
Last Name:WALTON
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:6800 WEST LOOP SOUTH
Mailing Address - Street 2:STE 400/450
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4528
Mailing Address - Country:US
Mailing Address - Phone:281-944-8020
Mailing Address - Fax:479-227-6607
Practice Address - Street 1:6800 WEST LOOP SOUTH
Practice Address - Street 2:STE 400/450
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4528
Practice Address - Country:US
Practice Address - Phone:281-944-8020
Practice Address - Fax:479-227-6607
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2023-12-19
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Provider Licenses
StateLicense IDTaxonomies
TXQ4543207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology