Provider Demographics
NPI:1285947747
Name:WALSH, LAUREN ASHLEY (OD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ASHLEY
Last Name:WALSH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:ASHLEY
Other - Last Name:KALUZNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:922 SE 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4779
Mailing Address - Country:US
Mailing Address - Phone:336-406-3589
Mailing Address - Fax:
Practice Address - Street 1:922 SE 35TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-4779
Practice Address - Country:US
Practice Address - Phone:336-406-3589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007625152W00000X
FLOPC 4674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist