1013032572 NPI number — DR. STEVEN DAVID WALSH O.D.

Table of content: DR. STEVEN DAVID WALSH O.D. (NPI 1013032572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013032572 NPI number — DR. STEVEN DAVID WALSH O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
STEVEN
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OPTOMETRY
Provider Other First Name:
STEVEN
Provider Other Middle Name:
WALSH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013032572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 TRAIL EAST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATASKALA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43062-9652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-863-9104
Provider Business Mailing Address Fax Number:
614-863-9379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 E BROAD ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PATASKALA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43062-7573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-395-6998
Provider Business Practice Location Address Fax Number:
740-927-7042
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4500 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: O129462 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com