Healthcare Provider Details

I. General information

NPI: 1700851631
Provider Name (Legal Business Name): MICHAEL ANDREW WALBY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E ASH ST
PERRY FL
32347-2105
US

IV. Provider business mailing address

404 E ASH ST
PERRY FL
32347-2105
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-2200
  • Fax: 888-429-8421
Mailing address:
  • Phone: 850-584-2200
  • Fax: 888-429-8421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP1063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: