=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386639110
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD WALKER OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2005
-----------------------------------------------------
Last Update Date | 12/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6823 PINES RD SUITE B
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71129-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-688-3050
-----------------------------------------------------
Fax | 318-688-3233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6823 PINES RD SUITE B
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71129-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-688-3050
-----------------------------------------------------
Fax | 318-688-3233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 809097T
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 152W00000X
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------