Provider Demographics
NPI:1508044959
Name:WALKER, BOYD L (OD)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:L
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 1:3726 LAKE ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7663
Mailing Address - Country:US
Mailing Address - Phone:907-235-7745
Mailing Address - Fax:907-235-7710
Practice Address - Street 1:3726 LAKE ST STE A
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7663
Practice Address - Country:US
Practice Address - Phone:907-235-7745
Practice Address - Fax:907-235-7710
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK68152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0854070001OtherDMERC
AKOP0680Medicaid
AKOP0680Medicaid
AKK0000PHDSRMedicare PIN