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General NPI Number Information
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NPI Number | 1760410807
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Entity Type | Individual
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Provider Name | MELISSA MARIE WALTERS OD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | CORNER OF ROUTE N12 AND N7
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504
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Country | US
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Telephone | 928-729-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 649
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504-0649
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Country | US
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Telephone | 928-729-8000
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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 | OPT.005079
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License Number State | OH
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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 | TUV008537
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License Number State | NY
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