Provider Demographics
NPI:1275641359
Name:WALKER, TIMOTHY PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAUL
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 1:1601 W JONES AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1731
Mailing Address - Country:US
Mailing Address - Phone:580-255-7399
Mailing Address - Fax:580-255-7879
Practice Address - Street 1:1601 W JONES AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1731
Practice Address - Country:US
Practice Address - Phone:580-255-7399
Practice Address - Fax:580-255-7879
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1121140001Medicare NSC
OKU33444Medicare UPIN