MEDICARE: BOYD L WALKER OD APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	068	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588655203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYD L WALKER OD APC

Provider Business Mailing Address
First Line	:	3726 LAKE ST
Second Line	:	SUITE A
City	:	HOMER
State	:	AK
Zip	:	99603-7647
Country	:	US
Telephone Number	:	907-235-7745
Fax Number	:	907-235-7710

Provider Business Practice Location Address
First Line	:	3726 LAKE ST
Second Line	:	SUITE A
City	:	HOMER
State	:	AK
Zip	:	99603-7647
Country	:	US
Telephone Number	:	907-235-7745
Fax Number	:	907-235-7710

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	BOYD LEE WALKER
Credential	:	OD
Telephone Number	:	907-235-7745

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	09/18/2008

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