Healthcare Provider Details

I. General information

NPI: 1538139480
Provider Name (Legal Business Name): ROBERT L WALKER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 YARDLEY RD
YARDLEY PA
19067-3060
US

IV. Provider business mailing address

2319 YARDLEY RD
YARDLEY PA
19067-3060
US

V. Phone/Fax

Practice location:
  • Phone: 215-493-2105
  • Fax: 215-493-4650
Mailing address:
  • Phone: 215-493-2105
  • Fax: 215-493-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000145
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA002887
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTO000580
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: