Individual
DR. DARRELL RAY WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
107 KINGSWAY RD, BRANDON, FL 33510-4601
(813) 689-2222
(813) 689-0802
Mailing address
107 KINGSWAY RD, BRANDON, FL 33510-4601
(813) 689-2222
(813) 689-0802
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC1125
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19792
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/06/2006
Last updated
04/11/2008
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