Provider Demographics
NPI:1821466533
Name:WALKOVIAK OPTOMETRY LLC
Entity Type:Organization
Organization Name:WALKOVIAK OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKOVIAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-428-9766
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-0120
Mailing Address - Country:US
Mailing Address - Phone:763-428-9766
Mailing Address - Fax:763-428-9052
Practice Address - Street 1:21615 S DIAMOND LAKE RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-8893
Practice Address - Country:US
Practice Address - Phone:763-428-9766
Practice Address - Fax:763-428-9052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty