Basic Information
| Provider Information | |||||||||
| NPI: | 1255825709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 CANALSIDE ST APT 3022 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042542921 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1774 PAXVILLE HWY | ||||||||
| Address2: | |||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291025071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034352494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2018 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2072 | SC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.