Provider Demographics
NPI:1952319717
Name:WALKER, BRUCE DAVIDSON (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVIDSON
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 1:3 PENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2220
Mailing Address - Country:US
Mailing Address - Phone:908-604-9151
Mailing Address - Fax:908-766-3301
Practice Address - Street 1:21 S FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1420
Practice Address - Country:US
Practice Address - Phone:908-766-5469
Practice Address - Fax:908-766-5469
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00408000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU26916Medicare UPIN
NJWA521575Medicare ID - Type Unspecified