Provider Demographics
NPI:1134388374
Name:WALTER M. FIERSON, M.D.,P.C.
Entity type:Organization
Organization Name:WALTER M. FIERSON, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:FIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-304-7081
Mailing Address - Street 1:1245 W HUNTINGTON DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6333
Mailing Address - Country:US
Mailing Address - Phone:626-304-7081
Mailing Address - Fax:626-304-1078
Practice Address - Street 1:1245 W HUNTINGTON DR
Practice Address - Street 2:SUITE 109
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6333
Practice Address - Country:US
Practice Address - Phone:626-304-7081
Practice Address - Fax:626-304-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29165207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G291650Medicaid
CAWC29165COtherMEDICARE ID TYPE UNSPECIFIED
CAWC29165COtherMEDICARE ID TYPE UNSPECIFIED
CA00G291650Medicaid