Provider Demographics
NPI:1720244387
Name:WALTON, SEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:WALTON
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 1:3001 SW 24TH AVE APT 2015
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7842
Mailing Address - Country:US
Mailing Address - Phone:850-443-0301
Mailing Address - Fax:
Practice Address - Street 1:2393 SW COLLEGE RD
Practice Address - Street 2:PLAZA 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1661
Practice Address - Country:US
Practice Address - Phone:352-291-5098
Practice Address - Fax:352-414-5525
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010970400Medicaid