Provider Demographics
NPI:1447598149
Name:WALKER, MARK BARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BARRETT
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 11TH AVE W
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5313
Mailing Address - Country:US
Mailing Address - Phone:425-830-2707
Mailing Address - Fax:
Practice Address - Street 1:1300 SW 7TH ST
Practice Address - Street 2:#105
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5225
Practice Address - Country:US
Practice Address - Phone:425-687-7700
Practice Address - Fax:425-687-7703
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036470207W00000X
IDM-8998207W00000X
ORMD-26380207W00000X
CAC52196207W00000X
NMMD2012-0678207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01373109Medicaid
COG76966Medicare UPIN