Provider Demographics
NPI:1952672404
Name:AMY D WALDEN PC
Entity Type:Organization
Organization Name:AMY D WALDEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-770-9828
Mailing Address - Street 1:11537 HANBURY MANOR BLVD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-7180
Mailing Address - Country:US
Mailing Address - Phone:317-770-9828
Mailing Address - Fax:
Practice Address - Street 1:13230 HARRELL PKWY
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3317
Practice Address - Country:US
Practice Address - Phone:317-770-1633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002878152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU67553Medicare UPIN