Provider Demographics
NPI:1386639110
Name:WALKER, DONALD (OD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
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 1:6823 PINES RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-5205
Mailing Address - Country:US
Mailing Address - Phone:318-688-3050
Mailing Address - Fax:318-688-3233
Practice Address - Street 1:6823 PINES RD
Practice Address - Street 2:SUITE B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-5205
Practice Address - Country:US
Practice Address - Phone:318-688-3050
Practice Address - Fax:318-688-3233
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA809097T152W00000X
LA152W00000X332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1342696Medicaid
LAT19581Medicare UPIN
LAP00634832Medicare PIN
LA1342696Medicaid
LA0359340001Medicare NSC