Provider Demographics
NPI:1710906219
Name:WALKER, TERRY WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:WILLIAM
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 1:330 N SELTZER ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1403
Mailing Address - Country:US
Mailing Address - Phone:419-462-4556
Mailing Address - Fax:419-462-4557
Practice Address - Street 1:330 N SELTZER ST
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1403
Practice Address - Country:US
Practice Address - Phone:419-462-4556
Practice Address - Fax:419-462-4557
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201823OtherUNITED HEALTHCARE
OH000000241963OtherANTHEM
OH2263161Medicaid
OH410049534OtherMEDICARE RAILROAD
OH410049534OtherMEDICARE RAILROAD
OH2201823OtherUNITED HEALTHCARE
OH2263161Medicaid
4053583Medicare PIN