Provider Demographics
NPI:1912032715
Name:MARC S WALKER OD PC
Entity Type:Organization
Organization Name:MARC S WALKER OD PC
Other - Org Name:FAMILY VISION CLINIC & OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-867-3342
Mailing Address - Street 1:718 E PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3620
Mailing Address - Country:US
Mailing Address - Phone:970-867-3342
Mailing Address - Fax:970-867-7751
Practice Address - Street 1:718 E PLATTE AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3620
Practice Address - Country:US
Practice Address - Phone:970-867-3342
Practice Address - Fax:970-867-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79679757Medicaid
CO08128498Medicaid
CO08128498Medicaid
CO448098Medicare PIN
CO448088Medicare PIN
CO79679757Medicaid