MEDICARE: ANDREA WALKER

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	AR2724	AR
2	152W00000X	Optometrist	2724	AR

General Provider Information

NPI Number	:	1780067587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA WALKER

Provider Business Mailing Address
First Line	:	102 TOWNE CENTRE DR
Second Line	:	STE 1
City	:	MAUMELLE
State	:	AR
Zip	:	72113-7756
Country	:	US
Telephone Number	:	501-803-3937
Fax Number	:	501-803-3962

Provider Business Practice Location Address
First Line	:	115 AUDUBON DR
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-7408
Country	:	US
Telephone Number	:	501-803-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	05/02/2024

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Directions to “ ANDREA WALKER ” Practice Location

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