Provider Demographics
NPI:1952470767
Name:ROTKIS, WALTER MOLDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:MOLDEN
Last Name:ROTKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1221 MADISON STREET
Mailing Address - Street 2:SUITE 1420
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1367
Mailing Address - Country:US
Mailing Address - Phone:206-386-2516
Mailing Address - Fax:206-386-2515
Practice Address - Street 1:1221 MADISON ST.
Practice Address - Street 2:SUITE 1420
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1367
Practice Address - Country:US
Practice Address - Phone:206-386-2516
Practice Address - Fax:202-386-2515
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016739207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911391536OtherCOMMERCIAL OCN SEATTLE
WA911391536OtherPREMERA OCN SEATTLE
WA501OtherLABOR & INDUSTRY OCN SEA
WAR775OtherREGENCE BS OCN
WA1044197Medicaid
WAA05519Medicare UPIN
WA1044197Medicaid
WAG8851135Medicare PIN