Provider Demographics
NPI:1891766606
Name:WALKER, JON SCOTT (OD, MS, FAAO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:SCOTT
Last Name:WALKER
Suffix:
Gender:M
Credentials:OD, MS, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7227
Mailing Address - Country:US
Mailing Address - Phone:904-553-2426
Mailing Address - Fax:904-363-2263
Practice Address - Street 1:10300 SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0743
Practice Address - Country:US
Practice Address - Phone:904-363-8282
Practice Address - Fax:904-363-2263
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3558152W00000X
MN2011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84030Medicare UPIN