MEDICARE: DR. LISA ANN WALKER OD OPTOMETRY

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	2003	OK

General Provider Information

NPI Number	:	1871559575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ANN WALKER OD OPTOMETRY

Provider Business Mailing Address
First Line	:	106 N MAIN ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-4752
Country	:	US
Telephone Number	:	580-243-2020
Fax Number	:	580-243-2040

Provider Business Practice Location Address
First Line	:	106 N MAIN ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-4752
Country	:	US
Telephone Number	:	580-243-2020
Fax Number	:	580-243-2040

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

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	02/15/2008

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