Individual
DR. DEREK ALAN WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
400 E ADAMS AVE, RIVERTON, WY 82501-4413
(307) 856-3937
(307) 856-1306
Mailing address
400 E ADAMS AVE, RIVERTON, WY 82501-4413
(307) 856-3937
(307) 856-1306
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
413T
WY
152W00000X
Optometrist
8527006-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U000078885
MEDICARE PTAN
UT
Enumeration date
10/07/2011
Last updated
07/21/2022
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