Provider Demographics
NPI:1750331161
Name:WALKER, MEGAN MARIE (OD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:WALKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:151 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1625
Mailing Address - Country:US
Mailing Address - Phone:334-793-2633
Mailing Address - Fax:334-794-1626
Practice Address - Street 1:151 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1625
Practice Address - Country:US
Practice Address - Phone:334-793-2633
Practice Address - Fax:334-794-1626
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B28-TA-713152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCN3942Medicare PIN
P00336454Medicare PIN
051557806Medicare PIN