Provider Demographics
NPI:1831394964
Name:KIM WALTERS OD PA
Entity type:Organization
Organization Name:KIM WALTERS OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PA
Authorized Official - Phone:828-645-0061
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-0564
Mailing Address - Country:US
Mailing Address - Phone:828-645-0061
Mailing Address - Fax:828-645-0602
Practice Address - Street 1:49 N BUNCOMBE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9608
Practice Address - Country:US
Practice Address - Phone:828-645-0061
Practice Address - Fax:828-645-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09003OtherBLUE CROSS BLUE SHEILD OF NC
NC7909003Medicaid
NC410049043OtherRAIL ROAD MEDICAE
NC7909003Medicaid
NC410049043OtherRAIL ROAD MEDICAE
NC4082990001Medicare NSC