Individual
KEVIN B WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1010 N WASHINGTON ST, JANESVILLE, WI 53548-1561
(608) 741-6794
Mailing address
1010 N WASHINGTON ST, JANESVILLE, WI 53548-1561
(608) 741-6794
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2571
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38589700
—
WI
Enumeration date
11/08/2006
Last updated
07/08/2007
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