Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4500 | OH |
NPI | 1013032572 |
---|---|
Provider Name | Dr. Steven David Walsh |
First Address | Pataskala, OH 43062-9652 |
Second Address | Pataskala, OH 43062-7573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 22/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
O129462 | (05) | OH |
U48379 | (02) | OH |