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General NPI Number Information
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NPI Number | 1477657013
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Entity Type | Organization
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Legal Business Name | GARY P WALKER OD PC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 1067 EASTLAND DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-6747
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Country | US
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Telephone | 208-733-1944
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Fax | 208-734-4984
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Provider Business Mailing Address
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Address Line | 1067 EASTLAND DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-6747
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Country | US
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Telephone | 208-733-1944
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Fax | 208-734-4984
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JARED P WALKER
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Credential | O.D.
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Telephone | 208-733-1944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-0539
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License Number State | ID
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