Provider Demographics
NPI:1598718348
Name:WALKER, BRADFORD P (OD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:P
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 1:165 W HASELTINE ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2552
Mailing Address - Country:US
Mailing Address - Phone:608-647-8995
Mailing Address - Fax:608-647-2569
Practice Address - Street 1:165 W HASELTINE ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2552
Practice Address - Country:US
Practice Address - Phone:608-647-8995
Practice Address - Fax:608-647-2569
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2526-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1598718348Medicaid
WIP01423137Medicare PIN
WIK400178688Medicare PIN
WI001247805Medicare PIN
WI4564OtherDEAN HEALTH INSURANCE
U34954Medicare UPIN