Basic Information
| Provider Information | |||||||||
| NPI: | 1033135116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALMAN | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 LORD BALTIMORE DR | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433162101 | ||||||||
| FaxNumber: | 4102656068 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 E PADONIA AVE | ||||||||
| Address2: | |||||||||
| City: | TIMONIUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106671910 | ||||||||
| FaxNumber: | 4106671909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OP345 | DC | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OE00434ST | PA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | TA0607 | MD | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.