Provider Demographics
NPI:1881932309
Name:JOHN WALTON OD PC
Entity type:Organization
Organization Name:JOHN WALTON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-322-5385
Mailing Address - Street 1:3028 E DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4391
Mailing Address - Country:US
Mailing Address - Phone:812-323-7666
Mailing Address - Fax:812-323-7653
Practice Address - Street 1:3200 JOHN WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-9153
Practice Address - Country:US
Practice Address - Phone:812-277-1275
Practice Address - Fax:812-323-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ18001851A & B152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty