Provider Demographics
NPI:1942932678
Name:WALTERS, BARBARA (LDO)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 EIGHTEEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-8605
Mailing Address - Country:US
Mailing Address - Phone:864-639-0234
Mailing Address - Fax:864-639-4012
Practice Address - Street 1:1286 EIGHTEEN MILE RD
Practice Address - Street 2:
Practice Address - City:CENTRAL
Practice Address - State:SC
Practice Address - Zip Code:29630-8605
Practice Address - Country:US
Practice Address - Phone:864-639-0234
Practice Address - Fax:864-639-4012
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC782156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician