Provider Demographics
NPI:1972758837
Name:WALTER, JEFFREY SCOTT (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:WALTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 STAGE RD
Mailing Address - Street 2:SUITE 44
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-8374
Mailing Address - Country:US
Mailing Address - Phone:901-373-4207
Mailing Address - Fax:901-373-4208
Practice Address - Street 1:6025 STAGE RD
Practice Address - Street 2:SUITE 44
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-8374
Practice Address - Country:US
Practice Address - Phone:901-373-4207
Practice Address - Fax:901-373-4208
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist