Provider Demographics
NPI:1912905423
Name:WALTON, PAUL LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LOUIS
Last Name:WALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1901 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1303
Mailing Address - Country:US
Mailing Address - Phone:317-925-2200
Mailing Address - Fax:317-921-6609
Practice Address - Street 1:1901 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1303
Practice Address - Country:US
Practice Address - Phone:317-925-2200
Practice Address - Fax:317-921-6609
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1035918A152WC0802X
IN01035918A152WC0802X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100228320BMedicaid
IN332150AMedicare ID - Type Unspecified
IN100228320AMedicare ID - Type Unspecified
IN595540AMedicare ID - Type Unspecified
IN100228320BMedicaid