Provider Demographics
NPI:1619957024
Name:WALKER, STEPHEN CURTIS (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CURTIS
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 1:6 BAYA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508
Mailing Address - Country:US
Mailing Address - Phone:505-473-5100
Mailing Address - Fax:505-473-5104
Practice Address - Street 1:3530 ZAFARANO DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:505-473-5100
Practice Address - Fax:505-473-5104
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM489152W00000X
NMNM489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00P942OtherBCBS
NM00E14SMedicare UPIN