Provider Demographics
NPI:1750637948
Name:WALKER EYECARE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:WALKER EYECARE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-376-0893
Mailing Address - Street 1:350 N MILWAUKEE ST STE 1188
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9128
Mailing Address - Country:US
Mailing Address - Phone:208-376-0893
Mailing Address - Fax:208-376-3029
Practice Address - Street 1:350 N MILWAUKEE ST STE 1188
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9128
Practice Address - Country:US
Practice Address - Phone:208-376-0893
Practice Address - Fax:208-376-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487840328OtherNPI TYPE 1
1487840328OtherNPI TYPE 1