MEDICARE: DR. WALTER L CHOATE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD0000000716	TN
2	152WC0802X	Corneal and Contact Management Optometrist	OD0000000716	TN
3	152WL0500X	Low Vision Rehabilitation Optometrist	OD0000000716	TN
4	152WP0200X	Pediatric Optometrist	OD0000000716	TN
5	152WS0006X	Sports Vision Optometrist	OD0000000716	TN
6	152WX0102X	Occupational Vision Optometrist	OD0000000716	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	410040172	OTHER	TN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0672520001	OTHER	TN	D MERC
2	2240170	OTHER	TN	UNITED HEALTHCARE TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	T-61213	OTHER	TN	HEALH SPRING TN
5	0028006	OTHER	TN	BLUECROSS BLUESHIELD TN
6	969368	OTHER	TN	AETNA

General Provider Information

NPI Number	:	1083608459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER L CHOATE O.D.

Provider Business Mailing Address
First Line	:	306 NORTHCREEK BLVD
Second Line	:	STE.101
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-2086
Country	:	US
Telephone Number	:	615-851-7575
Fax Number	:	615-851-8725

Provider Business Practice Location Address
First Line	:	306 NORTHCREEK BLVD
Second Line	:	SUITE 101
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-2089
Country	:	US
Telephone Number	:	615-851-7575
Fax Number	:	615-851-8725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/07/2015

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