Provider Demographics
NPI:1780090977
Name:WALMAN EYE POD, LLC
Entity type:Organization
Organization Name:WALMAN EYE POD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-236-1999
Mailing Address - Street 1:10615 W THUNDERBIRD BLVD
Mailing Address - Street 2:D180
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3033
Mailing Address - Country:US
Mailing Address - Phone:623-236-1999
Mailing Address - Fax:623-236-1998
Practice Address - Street 1:10615 W THUNDERBIRD BLVD
Practice Address - Street 2:D180
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3033
Practice Address - Country:US
Practice Address - Phone:623-236-1999
Practice Address - Fax:623-236-1998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALMAN EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier