=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003993122
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | R. SCOTT WALKER OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 11/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 262 MIAMI AVE W
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34285-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-485-2468
-----------------------------------------------------
Fax | 941-486-8263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 262 MIAMI AVE W
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34285-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-485-2468
-----------------------------------------------------
Fax | 941-486-8263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | OPC1124
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------