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General NPI Number Information
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NPI Number | 1417069196
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Entity Type | Organization
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Legal Business Name | WALZ VISION PA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 5425 S PADRE ISLAND DR SUITE 119-B
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-5301
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Country | US
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Telephone | 361-993-7778
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Fax | 361-993-7846
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Provider Business Mailing Address
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Address Line | 5425 S PADRE ISLAND DR SUITE 119-B
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-5301
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Country | US
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Telephone | 361-993-7778
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Fax | 361-993-7846
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Authorized Official
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Title or Position | PRESIDENT OPTOMETRIST
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Name | TIM J WALZ
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Credential | O.D.
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Telephone | 361-993-7778
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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 | TX4039TG
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License Number State | TX
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