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General NPI Number Information
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NPI Number | 1306833421
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Entity Type | Individual
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Provider Name | CHRISTA L WALLING O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1451 JASON RD
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City | GREENFIELD
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State | IN
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Zip | 46140-1039
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Country | US
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Telephone | 317-462-6601
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Fax | 317-462-6625
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Provider Business Mailing Address
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Address Line | 10170 N 725 W
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City | CARTHAGE
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State | IN
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Zip | 46115-9402
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Country | US
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Telephone | 765-565-6103
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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 | 18003127A
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License Number State | IN
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