Provider Demographics
NPI:1922271899
Name:BILLIE L. WALSH OD
Entity type:Organization
Organization Name:BILLIE L. WALSH OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-712-1212
Mailing Address - Street 1:4120 E 51ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3639
Mailing Address - Country:US
Mailing Address - Phone:918-712-1212
Mailing Address - Fax:918-712-1212
Practice Address - Street 1:4120 E 51ST ST STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3639
Practice Address - Country:US
Practice Address - Phone:918-712-1212
Practice Address - Fax:918-712-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2112332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0828210001Medicare NSC