Individual
CHARLES LEWIS WALVOORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9 RICHLAND MEDICAL PARK DR, SUITE 340, COLUMBIA, SC 29203-6859
(803) 434-2020
(803) 434-1581
Mailing address
PO BOX 402145, ATLANTA, GA 30384-2145
(803) 296-7305
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
7636
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076367
—
SC
Enumeration date
10/12/2005
Last updated
09/29/2014
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