MEDICARE: DONALD WALKER OD

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	152W00000X	Optometrist	809097T	LA
2	332H00000X	Eyewear Supplier	152W00000X	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386639110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD WALKER OD

Provider Business Mailing Address
First Line	:	6823 PINES RD
Second Line	:	SUITE B
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5205
Country	:	US
Telephone Number	:	318-688-3050
Fax Number	:	318-688-3233

Provider Business Practice Location Address
First Line	:	6823 PINES RD
Second Line	:	SUITE B
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5205
Country	:	US
Telephone Number	:	318-688-3050
Fax Number	:	318-688-3233

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	12/16/2008

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