Provider Demographics
NPI:1578678520
Name:WALKER, PATRIA DULCE (OD)
Entity Type:Individual
Prefix:
First Name:PATRIA
Middle Name:DULCE
Last Name:WALKER
Suffix:
Gender:F
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-0400
Mailing Address - Country:US
Mailing Address - Phone:505-286-2020
Mailing Address - Fax:505-286-2244
Practice Address - Street 1:1917 OLD ROUTE 66
Practice Address - Street 2:EDGEWOOD PLAZA
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015
Practice Address - Country:US
Practice Address - Phone:505-286-2020
Practice Address - Fax:505-286-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP1928Medicaid
NMU56695Medicare UPIN