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General NPI Number Information
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NPI Number | 1811997752
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Entity Type | Individual
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Provider Name | WALTER LEE BALL JR. OD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 7500 CENTURION PARKWAY SUITE 100 DACAF
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0517
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Country | US
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Telephone | 904-443-1383
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Fax | 904-928-5805
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Provider Business Mailing Address
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Address Line | 7500 CENTURION PARKWAY SUITE 100 DACAF
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0517
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Country | US
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Telephone | 904-443-1383
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Fax | 904-928-5805
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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 | 4348
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License Number State | MA
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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 | OPC3639
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License Number State | FL
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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 | 2141
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License Number State | NC
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