Provider Demographics
NPI:1528065455
Name:WALTER, ADAM MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MICHAEL
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 1:6751 N 72ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1746
Mailing Address - Country:US
Mailing Address - Phone:402-572-2020
Mailing Address - Fax:402-572-2150
Practice Address - Street 1:6751 N 72ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1746
Practice Address - Country:US
Practice Address - Phone:402-572-2020
Practice Address - Fax:402-572-2150
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3958152W00000X
NE1247152W00000X
IA02336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37083OtherBCBS
P00274869OtherRAILROAD MEDICARE
NE37083OtherBCBS
P00274869OtherRAILROAD MEDICARE