Provider Demographics
NPI:1275598286
Name:WALK, WILLIAM MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:WALK
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 1:71 OLD CLAIRTON ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236
Mailing Address - Country:US
Mailing Address - Phone:412-653-0277
Mailing Address - Fax:412-653-1141
Practice Address - Street 1:71 OLD CLAIRTON ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236
Practice Address - Country:US
Practice Address - Phone:412-653-0277
Practice Address - Fax:412-653-1141
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007120T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2173149OtherAETNA
PA1960435OtherBLUE SHIELD MEDICAL PROVI
PA324813OtherUPMC PROVIDER
WA634207OtherBCBS
634207REKMedicare ID - Type Unspecified
PA324813OtherUPMC PROVIDER
PA4999820001Medicare NSC
066709Medicare ID - Type UnspecifiedGROUP #