Provider Demographics
NPI:1548260409
Name:WALTON, REBECCA MAE (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MAE
Last Name:WALTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 OAK PARK RD NE
Mailing Address - Street 2:
Mailing Address - City:NEW SALISBURY
Mailing Address - State:IN
Mailing Address - Zip Code:47161-8401
Mailing Address - Country:US
Mailing Address - Phone:812-366-3147
Mailing Address - Fax:812-366-3151
Practice Address - Street 1:8010 OAK PARK RD NE
Practice Address - Street 2:
Practice Address - City:NEW SALISBURY
Practice Address - State:IN
Practice Address - Zip Code:47161-8401
Practice Address - Country:US
Practice Address - Phone:812-366-3147
Practice Address - Fax:812-366-3151
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002068B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410046068OtherRAILROAD MEDICARE
IN100128170AMedicaid
IN000000092237OtherANTHEM BCBS
IN000000092237OtherANTHEM BCBS
U06573Medicare UPIN
IN331190BMedicare ID - Type Unspecified
IN0300710001Medicare NSC