Provider Demographics
NPI:1609890417
Name:WALKER, MINDY MINH-NGUYET (OD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:MINH-NGUYET
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 1:2690 S WHITE RD STE 255
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2098
Mailing Address - Country:US
Mailing Address - Phone:408-274-9090
Mailing Address - Fax:408-274-9120
Practice Address - Street 1:2690 S WHITE RD STE 255
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2098
Practice Address - Country:US
Practice Address - Phone:408-274-9090
Practice Address - Fax:408-274-9120
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12129T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12129TOtherLICENSE NUMBER