Walter Woodhull Merriam, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

114080 Issued in NY

Practice address

5792 Widewaters Pkwy Ste 101
Syracuse, NY 13214-1847

Phone

(315) 422-4412

Fax

(315) 422-4432

NPI assigned

Aug 24, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eye Consultants of Syracuse PC

  • Durable Medical Equipment & Medical Supplies
  • Fulton, NY
  • NPI 1932892247
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556323200000",
    "number": "1912014200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5792 WIDEWATERS PKWY STE 101",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141847",
            "telephone_number": "315-422-4412",
            "fax_number": "315-422-4432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5792 WIDEWATERS PKWY STE 101",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141847",
            "telephone_number": "315-422-4412",
            "fax_number": "315-422-4432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRIAM",
        "first_name": "WALTER",
        "middle_name": "WOODHULL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2019-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "114080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00550032",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mia Elizabeth Merola
• Michael Francis Merola, NP-C
• Eric T Merrell, MD
• Melanie Merriam, RDH
• Stephen W Merriam, MD
• Christina Maria Anne Merrifield
• Stephen A Merrill, MD
• Steven Merrill, DO
• Marsha A. Merriweather, CASAC
• Desiree Mersfelder

• Ophthalmology Physician in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.