Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 33266 | MN |
NPI | 1013997188 |
---|---|
Provider Name | Christopher R Wallyn |
First Address | Hutchinson, MN 55350-0699 |
Second Address | Hutchinson, MN 55350-0699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 15/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
719700400 | (05) | MN |
E70816 | (02) |