Provider Demographics
NPI:1730330366
Name:PAUL F WALKER OD PC
Entity type:Organization
Organization Name:PAUL F WALKER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-636-7200
Mailing Address - Street 1:5908 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6748
Mailing Address - Country:US
Mailing Address - Phone:989-636-7200
Mailing Address - Fax:989-636-7210
Practice Address - Street 1:5908 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6748
Practice Address - Country:US
Practice Address - Phone:989-636-7200
Practice Address - Fax:989-636-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1750613Medicaid
MI1750613Medicaid
MI0E66501Medicare PIN