Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2206DT | KY |
N | 152W00000X | Optometrist | 4901005145 | MI |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2206DT | KY |
NPI | 1114404456 |
---|---|
Provider Name | Dr. Jessica S Walter |
First Address | Pikeville, KY 41501-9114 |
Second Address | Pikeville, KY 41501-9114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 16/12/2020 |