MEDICARE: AMY LYNN WALKOWIAK 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	3626	MN

General Provider Information

NPI Number	:	1982265765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LYNN WALKOWIAK OD

Provider Business Mailing Address
First Line	:	5115 BURNING TREE RD STE 311
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-1876
Country	:	US
Telephone Number	:	218-481-6027
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 BURNING TREE RD STE 311
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-1876
Country	:	US
Telephone Number	:	218-481-6027
Fax Number	:

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

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	04/01/2020

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