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General NPI Number Information
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NPI Number | 1164597357
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Entity Type | Individual
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Provider Name | PENNY E. WALTER OD
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8901 WISCONSIN AVE NNMC, OPTOMETRY CLINIC
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City | BETHESDA
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State | MD
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Zip | 20889-0001
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Country | US
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Telephone | 301-295-0070
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 83218
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City | GAITHERSBURG
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State | MD
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Zip | 20883-3218
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Country | US
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Telephone | 202-762-0926
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2344
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License Number State | WI
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