Provider Demographics
NPI:1114019114
Name:WALKER, ANN A (OD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:A
Last Name: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 1:11225 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1285
Mailing Address - Country:US
Mailing Address - Phone:810-694-3937
Mailing Address - Fax:810-694-9876
Practice Address - Street 1:11225 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1285
Practice Address - Country:US
Practice Address - Phone:810-694-3937
Practice Address - Fax:810-694-9876
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09945464OtherHEALTHPLUS OF MICHIGAN
16485OtherM-CARE
1006992OtherMCLAREN HEALTHPLAN
MI900B511570OtherBLUE CROSS BLUE SHIELD
MI943020553Medicaid
N54540002Medicare ID - Type Unspecified
4663080001Medicare ID - Type UnspecifiedADMINSTAR FEDERAL
MI900B511570OtherBLUE CROSS BLUE SHIELD
16485OtherM-CARE