MEDICARE: RICHARD L 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
1	152W00000X	Optometrist	27OA03548	NJ
2	152W00000X	Optometrist	0799G	NH

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	:	1710985866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD L WALKER O.D.

Provider Business Mailing Address
First Line	:	PO BOX 5001
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5001
Country	:	US
Telephone Number	:	603-356-6045
Fax Number	:	603-356-4823

Provider Business Practice Location Address
First Line	:	3073 WHITE MOUNTAIN HIGHWAY
Second Line	:	THE MEMORIAL HOSPITAL
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5001
Country	:	US
Telephone Number	:	603-356-6045
Fax Number	:	603-356-4823

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	01/19/2010

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