Individual
DR. BRANDON R WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1051 COLUMBIA AVE, CONNELL, WA 99326-8702
(509) 488-5256
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5250
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
6664178-9934
UT
152W00000X
Optometrist
Primary
OD60040766
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2034643
—
WA
01
—
OD60040766
DOH LICENSE
WA
Enumeration date
02/28/2008
Last updated
12/01/2022
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