Provider Demographics
NPI:1144044934
Name:WALTERS, SOPHIA (LICENSED OPTICIAN)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CORNUS DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6501
Mailing Address - Country:US
Mailing Address - Phone:718-715-6061
Mailing Address - Fax:
Practice Address - Street 1:135 WILLOW LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6574
Practice Address - Country:US
Practice Address - Phone:678-432-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician