Provider Demographics
NPI:1538139480
Name:WALKER, ROBERT L (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
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 1:2319 YARDLEY RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3060
Mailing Address - Country:US
Mailing Address - Phone:215-493-2105
Mailing Address - Fax:215-493-4650
Practice Address - Street 1:2319 YARDLEY RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-3060
Practice Address - Country:US
Practice Address - Phone:215-493-2105
Practice Address - Fax:215-493-4650
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000145152W00000X
NJOA002887152W00000X
NJTO000580152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092637OtherBLUE SHIELD HORIZON
PA092637OtherBLUE SHIELD HIGHMARK
NJ092637OtherBS NJ PLUS
023480000OtherKEYSTONE AND AMERIHEALTH
PA092637OtherINDEP BC PERSONAL CHOICE
PA3208OtherAETNA
PA3208OtherAETNA
023480000OtherKEYSTONE AND AMERIHEALTH
PA092637OtherBLUE SHIELD HIGHMARK