Provider Demographics
NPI:1407826084
Name:WALKER, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:STE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:3155 COBB PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5535
Practice Address - Country:US
Practice Address - Phone:770-644-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0950152W00000X
GA2282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27556Medicare ID - Type Unspecified
AZ27561Medicare ID - Type Unspecified
AZU63926Medicare UPIN
AZWCKHL51Medicare ID - Type Unspecified
AZWCKHL138Medicare ID - Type Unspecified
AZ27557Medicare ID - Type Unspecified
AZ27558Medicare ID - Type Unspecified
AZ27559Medicare ID - Type Unspecified
AZ368060Medicaid
AZ27560Medicare ID - Type Unspecified
AZ27555Medicare ID - Type Unspecified