MEDICARE: WALTER DONACH 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	OA-004538	NJ
2	152W00000X	Optometrist	TUV-004396	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245386549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER DONACH O.D.

Provider Business Mailing Address
First Line	:	17 SPARROW LN
Second Line	:
City	:	WOODBURY
State	:	NY
Zip	:	11797-3206
Country	:	US
Telephone Number	:	516-528-3695
Fax Number	:	516-224-0991

Provider Business Practice Location Address
First Line	:	6110 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1568
Country	:	US
Telephone Number	:	201-861-1144
Fax Number	:	201-868-3577

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

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	02/22/2011

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