MEDICARE: MR. MICHAEL WALKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1366588386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL WALKER

Provider Business Mailing Address
First Line	:	1619 W 3RD ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-5113
Country	:	US
Telephone Number	:	580-225-5600
Fax Number	:	580-225-5610

Provider Business Practice Location Address
First Line	:	1619 W 3RD ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-5113
Country	:	US
Telephone Number	:	580-225-5600
Fax Number	:	580-225-5610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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