Provider Demographics
NPI:1780656884
Name:WALKER, NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BROCKMAN MCCLIMON RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6608
Mailing Address - Country:US
Mailing Address - Phone:864-989-1432
Mailing Address - Fax:
Practice Address - Street 1:415 BROCKMAN MCCLIMON RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651
Practice Address - Country:US
Practice Address - Phone:864-989-1432
Practice Address - Fax:864-896-8039
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006935152W00000X
SC1694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV08031Medicare UPIN
NYC434E36991Medicare PIN