Provider Demographics
NPI:1992828719
Name:FLORA, WALTER III (OD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:FLORA
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19217 GULF BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIAN SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2111
Mailing Address - Country:US
Mailing Address - Phone:813-760-6909
Mailing Address - Fax:888-505-6009
Practice Address - Street 1:19217 GULF BLVD
Practice Address - Street 2:
Practice Address - City:INDIAN SHORES
Practice Address - State:FL
Practice Address - Zip Code:33785-2111
Practice Address - Country:US
Practice Address - Phone:813-760-6909
Practice Address - Fax:888-505-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19972COtherMEDICARE PTAN
FL19972COtherMEDICARE PTAN