Provider Demographics
NPI:1285626093
Name:WALKER, MARSHALL K (OD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:K
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 1:1302 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IA
Mailing Address - Zip Code:52342-2308
Mailing Address - Country:US
Mailing Address - Phone:641-484-2020
Mailing Address - Fax:641-484-7073
Practice Address - Street 1:1302 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IA
Practice Address - Zip Code:52342-2308
Practice Address - Country:US
Practice Address - Phone:641-484-2020
Practice Address - Fax:641-484-7073
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01698152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA410039300OtherRAILROAD MEDICARE
IA410039300OtherRAILROAD MEDICARE