MEDICARE: OTIS BENNETT WALTON IV MD

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	207W00000X	Ophthalmology Physician	Q4543	TX

General Provider Information

NPI Number	:	1942591839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OTIS BENNETT WALTON IV MD

Provider Business Mailing Address
First Line	:	6800 WEST LOOP SOUTH
Second Line	:	STE 400/450
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4528
Country	:	US
Telephone Number	:	281-944-8020
Fax Number	:	281-849-7505

Provider Business Practice Location Address
First Line	:	6800 WEST LOOP SOUTH
Second Line	:	STE 400/450
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4528
Country	:	US
Telephone Number	:	281-944-8020
Fax Number	:	281-849-7505

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

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	07/24/2024

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