Provider Demographics
NPI:1548368632
Name:WALSH, JUDITH K (OD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:K
Last Name:WALSH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:21237 S LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2046
Mailing Address - Country:US
Mailing Address - Phone:815-469-8541
Mailing Address - Fax:815-469-8126
Practice Address - Street 1:21237 S LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2046
Practice Address - Country:US
Practice Address - Phone:815-469-8541
Practice Address - Fax:815-469-8106
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.008869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09922174OtherBLUE CROSS/BLUE SHIELD
ILK52617Medicare PIN