Provider Demographics
NPI:1659503159
Name:WALZ, ALLISON SUE (OD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:SUE
Last Name:WALZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3625
Mailing Address - Country:US
Mailing Address - Phone:312-504-6477
Mailing Address - Fax:
Practice Address - Street 1:1000 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8616
Practice Address - Country:US
Practice Address - Phone:630-355-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist