Provider Demographics
NPI:1972731461
Name:WALKER, MARK ALLAN JR (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLAN
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:2746 OLD US 20 W
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1364
Mailing Address - Country:US
Mailing Address - Phone:574-293-3545
Mailing Address - Fax:574-522-0599
Practice Address - Street 1:2746 OLD US 20 W
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1364
Practice Address - Country:US
Practice Address - Phone:574-293-3545
Practice Address - Fax:574-522-0599
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2012-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN18003605A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist