Provider Demographics
NPI:1033290895
Name:WALKER, MICHAEL P (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:WALKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-4324
Mailing Address - Country:US
Mailing Address - Phone:814-724-2020
Mailing Address - Fax:814-337-1150
Practice Address - Street 1:1039 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4324
Practice Address - Country:US
Practice Address - Phone:814-724-2020
Practice Address - Fax:814-337-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000830152W00000X
NCNC1574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391901OtherNVA PROVIDER NUMBER
PAOEG000830OtherPA LICENSE NUMBER
PAPA830OtherVBA PROVIDER NUMBER
NCNC1574OtherNC LICENSE NUMBER
PA205057OtherUPMC NUMBER
PA205057OtherUPMC NUMBER
PA0149910001Medicare NSC
NCNC1574OtherNC LICENSE NUMBER
PAT30078Medicare UPIN