Provider Demographics
NPI:1134188030
Name:MORTON, WALTER FREDERICK (OD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:FREDERICK
Last Name:MORTON
Suffix:
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 1:7960 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3166
Mailing Address - Country:US
Mailing Address - Phone:303-761-2345
Mailing Address - Fax:303-761-3535
Practice Address - Street 1:7960 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3166
Practice Address - Country:US
Practice Address - Phone:303-761-2345
Practice Address - Fax:303-761-3535
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08916181Medicaid
CO1618OtherSTATE LICENSE NUMBER
CO43603Medicare ID - Type Unspecified
CO08916181Medicaid