Individual
DR. PHILIP E WALLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1124 S STATE ST, MCO 101H, BIG RAPIDS, MI 49307-2256
(231) 591-2020
(231) 591-3991
Mailing address
1124 S STATE ST, MCO 101H, BIG RAPIDS, MI 49307-2256
(231) 591-2020
(231) 591-3991
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003260
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0784610001030
ADMINISTAR
MI
05
—
4401699
—
MI
01
—
900006367
PRIORITY HEALTH
MI
01
—
999998001
VSP
MI
01
—
PW003260
BLUE CROSS
MI
Enumeration date
07/21/2006
Last updated
09/26/2012
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