Provider Demographics
NPI:1932213444
Name:WALZ, TIM JAMES (OD)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:JAMES
Last Name:WALZ
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 1:5425 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 119-B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5425 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 119-B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5301
Practice Address - Country:US
Practice Address - Phone:361-993-7778
Practice Address - Fax:361-993-7846
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX4039TG152W00000X
NM374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121623604Medicaid
TX121623604Medicaid
TXT83581Medicare UPIN