MEDICARE: DR. PHILLIP A WALKER O.D.

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	OK0852	OK
2	152WC0802X	Corneal and Contact Management Optometrist	852	OK
3	152WS0006X	Sports Vision Optometrist	852	OK
4	152WX0102X	Occupational Vision Optometrist	852	OK
5	156FX1900X	Orthoptist	852	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	730983594001	OTHER	OK	BLUE CROSS BLUE SHIELD
2	OKAAA3556	OTHER	OK	PTAN

General Provider Information

NPI Number	:	1982757829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP A WALKER O.D.

Provider Business Mailing Address
First Line	:	16135 NORTH MAY AVE
Second Line	:	SUITE A
City	:	EDMOND
State	:	OK
Zip	:	73013-0000
Country	:	US
Telephone Number	:	405-751-5638
Fax Number	:	405-752-1692

Provider Business Practice Location Address
First Line	:	16135 NORTH MAY AVE
Second Line	:	SUITE A
City	:	EDMOND
State	:	OK
Zip	:	73013-0000
Country	:	US
Telephone Number	:	405-751-5638
Fax Number	:	405-752-1692

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	03/17/2014

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Directions to “ DR. PHILLIP A WALKER O.D.” Practice Location

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