Active NPI
Kurt Walters, OD
- Optometrist
- Fitchburg, WI
National Provider Identifier
1740209717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2112
- Practice address
- 3051 Cahill Main
Fitchburg, WI 53711-7109 - Phone
- (608) 661-7200
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2112 | WI | Primary |
Addresses
Primary practice location
3051 Cahill Main
Fitchburg, WI 53711-7109
Mailing address
1265 John Q Hammons Dr
Madison, WI 53717-1941
Phone (608) 251-4156
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38527500 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2112 | WI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348444800000",
"number": "1740209717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1265 JOHN Q HAMMONS DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537171941",
"telephone_number": "608-251-4156",
"fax_number": "608-257-3842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3051 CAHILL MAIN",
"city": "FITCHBURG",
"state": "WI",
"postal_code": "537117109",
"telephone_number": "608-661-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "KURT",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2012-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "2112",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38527500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fitchburg, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.