Individual
DR. GEORGE W WALTERS, JR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
725 W MARKET ST, BOLIVAR, TN 38008-2242
(731) 658-5197
(731) 658-5245
Mailing address
PO BOX C, BOLIVAR, TN 38008-0391
(731) 658-5197
(731) 658-5245
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD0000000654
TN
152WC0802X
Corneal and Contact Management Optometrist
OD0000000654
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3594030
—
TN
Enumeration date
07/25/2006
Last updated
01/15/2008
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