Individual
DAWN K WALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
692 W RANDALL ST, COOPERSVILLE, MI 49404-1306
(616) 837-6847
(616) 837-9338
Mailing address
692 W RANDALL ST, COOPERSVILLE, MI 49404-1306
(616) 837-6847
(616) 837-9338
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002956
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900G065080
BCBS
MI
01
—
P00109551
RR MEDICARE
MI
Enumeration date
02/09/2007
Last updated
04/29/2008
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