Provider Demographics
NPI:1841805645
Name:WALTERS, MARY KATHRYN (OD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:SAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:306 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-3706
Mailing Address - Country:US
Mailing Address - Phone:979-836-3597
Mailing Address - Fax:979-277-0239
Practice Address - Street 1:2332 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-1756
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:817-378-0861
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist