Healthcare Provider Details

I. General information

NPI: 1396710364
Provider Name (Legal Business Name): DAVID SELLERS WALTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 06/05/2022
Certification Date: 06/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HAWTHORNE PLACE, SUITE 110
BOSTON MA
02114
US

IV. Provider business mailing address

8 HAWTHORNE PLACE, SUITE 110
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-227-3011
  • Fax: 617-227-3011
Mailing address:
  • Phone: 617-227-3011
  • Fax: 617-227-9538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number56943
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMA56943
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberMA56943
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number569453
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number56943
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA56943
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: