Provider Demographics
NPI:1851314355
Name:WALKER, NATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
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 1:30 S MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1725
Mailing Address - Country:US
Mailing Address - Phone:610-586-0651
Mailing Address - Fax:
Practice Address - Street 1:30 S MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1725
Practice Address - Country:US
Practice Address - Phone:610-586-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist