MEDICARE: DR. KRISTINA FREEMAN WALTS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT 001212	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GA2212	OTHER	GA	EYEMED

General Provider Information

NPI Number	:	1386774800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA FREEMAN WALTS O.D.

Provider Business Mailing Address
First Line	:	35 WIEUCA TRCE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3856
Country	:	US
Telephone Number	:	404-252-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 WIEUCA TRCE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3856
Country	:	US
Telephone Number	:	404-252-6250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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