Provider Demographics
NPI:1114180783
Name:WALSH, MEGAN (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:WESNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1402 WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2429
Mailing Address - Country:US
Mailing Address - Phone:570-343-2591
Mailing Address - Fax:570-343-3286
Practice Address - Street 1:200 MIFFLIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1982
Practice Address - Country:US
Practice Address - Phone:570-342-3145
Practice Address - Fax:570-343-3286
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102794393001Medicaid