Provider Demographics
NPI:1639551591
Name:WALSH, MEGHAN T (OD)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:T
Last Name:WALSH
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 CRESCENT PARK CIR UNIT 346
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7506
Mailing Address - Country:US
Mailing Address - Phone:708-574-5687
Mailing Address - Fax:
Practice Address - Street 1:1060 STATE ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4257
Practice Address - Country:US
Practice Address - Phone:630-283-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist