MEDICARE: DR. TERRY L WALTON 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	TUV003045-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437336088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY L WALTON O.D.

Provider Business Mailing Address
First Line	:	575 GLEN ST
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-2243
Country	:	US
Telephone Number	:	518-792-0518
Fax Number	:	518-792-4739

Provider Business Practice Location Address
First Line	:	575 GLEN ST
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-2243
Country	:	US
Telephone Number	:	518-792-0518
Fax Number	:	518-792-4739

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

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	04/19/2012

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