Provider Demographics
NPI:1396710364
Name:WALTON, DAVID SELLERS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SELLERS
Last Name:WALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HAWTHORNE PLACE, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-227-3011
Mailing Address - Fax:617-227-9538
Practice Address - Street 1:8 HAWTHORNE PLACE, SUITE 110
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-227-3011
Practice Address - Fax:617-227-3011
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56943207W00000X, 208000000X
MAMA56943207WX0009X, 207WX0110X, 207W00000X
MA569453207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM07105OtherBCBS MA
MA0190977Medicaid
MA700954OtherTUFTS HEALTH PLAN
MA0190977Medicaid
MA700954OtherTUFTS HEALTH PLAN