Provider Demographics
NPI:1982757829
Name:WALKER, PHILLIP A (OD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:A
Last Name:WALKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16135 NORTH MAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-0000
Mailing Address - Country:US
Mailing Address - Phone:405-751-5638
Mailing Address - Fax:405-752-1692
Practice Address - Street 1:16135 NORTH MAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-0000
Practice Address - Country:US
Practice Address - Phone:405-751-5638
Practice Address - Fax:405-752-1692
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK0852152W00000X, 152W00000X
OK852152WC0802X, 152WS0006X, 152WX0102X, 156FX1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK730983594001OtherBLUE CROSS BLUE SHIELD
OKOKAAA3556OtherPTAN
OK730983594001OtherBLUE CROSS BLUE SHIELD