MEDICARE: WALZ VISION PA

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	TX4039TG	TX

General Provider Information

NPI Number	:	1417069196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALZ VISION PA

Provider Business Mailing Address
First Line	:	5425 S PADRE ISLAND DR
Second Line	:	SUITE 119-B
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-5301
Country	:	US
Telephone Number	:	361-993-7778
Fax Number	:	361-993-7846

Provider Business Practice Location Address
First Line	:	5425 S PADRE ISLAND DR
Second Line	:	SUITE 119-B
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-5301
Country	:	US
Telephone Number	:	361-993-7778
Fax Number	:	361-993-7846

Authorized Official
Title or Position	:	PRESIDENT OPTOMETRIST
Name	:	TIM J WALZ
Credential	:	O.D.
Telephone Number	:	361-993-7778

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/21/2007

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Directions to “WALZ VISION PA ” Practice Location

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