Provider Demographics
NPI:1568510113
Name:PARK RAPIDS WALKER EYE CLINIC O.D., P.A.
Entity type:Organization
Organization Name:PARK RAPIDS WALKER EYE CLINIC O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WESTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-547-3666
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-0219
Mailing Address - Country:US
Mailing Address - Phone:218-547-3666
Mailing Address - Fax:218-547-6073
Practice Address - Street 1:107 6TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-0219
Practice Address - Country:US
Practice Address - Phone:218-547-3666
Practice Address - Fax:218-547-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN529414200Medicaid
MNC08269Medicare PIN
MN0516220002Medicare NSC
MNDF5991Medicare PIN