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General NPI Number Information
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NPI Number | 1609285006
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Entity Type | Individual
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Provider Name | WALTER S BERRY
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Gender | Male
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 1818 HAMPTON ST
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City | COLUMBIA
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State | SC
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Zip | 29201-3534
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Country | US
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Telephone | 803-254-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 WILLIAMS ST APT 112
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City | COLUMBIA
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State | SC
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Zip | 29201-2269
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Country | US
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Telephone |
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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 | 1836
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License Number State | SC
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