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General NPI Number Information
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NPI Number | 1609878990
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Entity Type | Individual
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Provider Name | WALTER H. EGENMAIER O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 09/03/2011
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Provider Practice Location Address
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Address Line | 101 NW 1ST ST SUITE 112
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City | EVANSVILLE
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State | IN
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Zip | 47708-1259
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Country | US
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Telephone | 812-426-2020
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Fax | 812-426-2828
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Provider Business Mailing Address
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Address Line | 101 NW 1ST ST SUITE 112
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City | EVANSVILLE
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State | IN
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Zip | 47708-1259
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Country | US
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Telephone | 812-426-2020
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Fax | 812-426-2828
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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 | 18002611
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1000DT
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1235
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License Number State | GA
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