Provider Demographics
NPI:1871645978
Name:WALKER, JOHN WARD (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARD
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 1:9071 CONDE LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7419
Mailing Address - Country:US
Mailing Address - Phone:707-836-0306
Mailing Address - Fax:707-836-0392
Practice Address - Street 1:9071 CONDE LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7419
Practice Address - Country:US
Practice Address - Phone:707-836-0306
Practice Address - Fax:707-836-0392
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10868 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0108680Medicaid
CAU68768Medicare UPIN
CADH193AMedicare PIN