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General NPI Number Information
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NPI Number | 1720256464
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Entity Type | Organization
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Legal Business Name | CARMEN WALKER
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 4900 CARLISLE PIKE
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City | MECHANICSBURG
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State | PA
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Zip | 17050-7709
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Country | US
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Telephone | 717-761-2295
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Fax | 717-761-0123
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Provider Business Mailing Address
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Address Line | 4900 CARLISLE PIKE
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City | MECHANICSBURG
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State | PA
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Zip | 17050-7709
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Country | US
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Telephone | 717-761-2295
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Fax | 717-761-0123
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CARMEN LYNN WALKER
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Credential |
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Telephone | 717-761-2295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 6000007102
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License Number State | PA
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