Individual
BILLIE L WALSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2836 E 101ST ST, TULSA, OK 74137-5601
(918) 712-1212
Mailing address
2836 E 101ST ST, TULSA, OK 74137-5601
(918) 712-1212
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2112
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100763780B
—
OK
01
—
731430244
FEDERAL TAX ID
OK
Enumeration date
03/20/2007
Last updated
05/01/2012
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