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NPI Code Detail

MEDICARE: DR. JADE MADISON WALKER O.D.

MEDICARE: DR. JADE MADISON WALKER O.D.
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
1152W00000XOptometrist1771SC
2152WL0500XLow Vision Rehabilitation Optometrist1771SC
3152W00000XOptometrist2369NC

General Provider Information

NPI Number : 1548607419
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JADE MADISON WALKER O.D.
Provider Business Mailing Address
First Line : 1800 AIRPARK DR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-1412
Country : US
Telephone Number : 843-477-0177
Fax Number :
Provider Business Practice Location Address
First Line : 1800 AIRPARK DR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-1412
Country : US
Telephone Number : 843-477-0177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2013
Last Update Date : 01/28/2022

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