Provider Demographics
NPI:1003993122
Name:WALKER, R. SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:SCOTT
Last Name:WALKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:262 MIAMI AVE W
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2301
Mailing Address - Country:US
Mailing Address - Phone:941-485-2468
Mailing Address - Fax:941-486-8263
Practice Address - Street 1:262 MIAMI AVE W
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2301
Practice Address - Country:US
Practice Address - Phone:941-485-2468
Practice Address - Fax:941-486-8263
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1124152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84030Medicare UPIN
FL19421Medicare ID - Type Unspecified
FL0401780001Medicare NSC