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General NPI Number Information
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NPI Number | 1235397449
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Entity Type | Organization
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Legal Business Name | JAMES P. WALSH O.D., LLC
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Dates
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Enumeration Date | 05/26/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 2300 W WHITE OAKS DR SAM'S CLUB OPTICAL
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City | SPRINGFIELD
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State | IL
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Zip | 62704-6423
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Country | US
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Telephone | 217-698-7662
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 CHECKERBERRY LN
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City | SPRINGFIELD
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State | IL
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Zip | 62711-7203
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Country | US
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Telephone | 217-698-3426
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JAMES P. WALSH
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Credential | O.D.
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Telephone | 217-698-3426
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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 | 046-008528
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License Number State | IL
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