MEDICARE: WALKOVIAK OPTOMETRY LLC

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	3441	MN

General Provider Information

NPI Number	:	1821466533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALKOVIAK OPTOMETRY LLC

Provider Business Mailing Address
First Line	:	PO BOX 120
Second Line	:
City	:	MONTICELLO
State	:	MN
Zip	:	55362-0120
Country	:	US
Telephone Number	:	763-428-9766
Fax Number	:	763-428-9052

Provider Business Practice Location Address
First Line	:	21615 S DIAMOND LAKE RD
Second Line	:
City	:	ROGERS
State	:	MN
Zip	:	55374-8893
Country	:	US
Telephone Number	:	763-428-9766
Fax Number	:	763-428-9052

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ASHLEY WALKOVIAK
Credential	:	O.D.
Telephone Number	:	763-428-9766

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/11/2015

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