Provider Demographics
NPI:1902581739
Name:MARSHALL WALKER, ASHLEY DOMONIQUE (OD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:DOMONIQUE
Last Name:MARSHALL WALKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21543 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1736
Mailing Address - Country:US
Mailing Address - Phone:718-217-0424
Mailing Address - Fax:
Practice Address - Street 1:21543 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1736
Practice Address - Country:US
Practice Address - Phone:718-217-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007209152W00000X
NYORT009949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist