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NPI Code Detail

MEDICARE: DR. JACQUELINE T. WALSH O.D.

MEDICARE: DR. JACQUELINE T. WALSH 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
1152W00000XOptometrist5166637-9934UT

General Provider Information

NPI Number : 1962548495
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE T. WALSH O.D.
Provider Business Mailing Address
First Line : 10522 SANTA GERTRUDES AVE
Second Line : APT 26
City : WHITTIER
State : CA
Zip : 90603-2762
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10522 SANTA GERTRUDES AVE
Second Line : APT 26
City : WHITTIER
State : CA
Zip : 90603-2762
Country : US
Telephone Number : 562-236-7395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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