Provider Demographics
NPI:1710985866
Name:WALKER, RICHARD L (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
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:PO BOX 5001
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-5001
Mailing Address - Country:US
Mailing Address - Phone:603-356-6045
Mailing Address - Fax:603-356-4823
Practice Address - Street 1:3073 WHITE MOUNTAIN HIGHWAY
Practice Address - Street 2:THE MEMORIAL HOSPITAL
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5001
Practice Address - Country:US
Practice Address - Phone:603-356-6045
Practice Address - Fax:603-356-4823
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA03548152W00000X
NH0799G152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1865102Medicaid
NJ1865102Medicaid
NJ118771DS4Medicare ID - Type Unspecified