Provider Demographics
NPI:1669585535
Name:BETTON, WALTER (OD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:BETTON
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 1:4244 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-1935
Mailing Address - Country:US
Mailing Address - Phone:276-647-3766
Mailing Address - Fax:276-647-4279
Practice Address - Street 1:4244 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24078-1935
Practice Address - Country:US
Practice Address - Phone:276-647-3766
Practice Address - Fax:276-647-4279
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000209152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W366W01Medicare PIN
VAT21347Medicare UPIN