Provider Demographics
NPI:1811008451
Name:WALKER, MARVIN (OD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
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 1:54 HILL ST
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-8923
Mailing Address - Country:US
Mailing Address - Phone:828-765-2020
Mailing Address - Fax:828-765-2451
Practice Address - Street 1:54 HILL ST
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8923
Practice Address - Country:US
Practice Address - Phone:828-765-2020
Practice Address - Fax:828-765-2451
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2270853OtherUNITED HEALTH CARE
NC8909946Medicaid
NC09946OtherBLUE CROSS/BLUE SHIELD
NC246416COtherRAILROAD MEDICARE
NC246416CMedicare ID - Type UnspecifiedMEDICARE
NC2270853OtherUNITED HEALTH CARE