Provider Demographics
NPI:1245416510
Name:WESLEY J WALKER, O.D. PLLC
Entity type:Organization
Organization Name:WESLEY J WALKER, O.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-658-6664
Mailing Address - Street 1:405 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-3029
Mailing Address - Country:US
Mailing Address - Phone:580-658-6664
Mailing Address - Fax:580-658-6665
Practice Address - Street 1:405 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-3029
Practice Address - Country:US
Practice Address - Phone:580-658-6664
Practice Address - Fax:580-658-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1036332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731172901001OtherBLUE CROSS BLUE SHIELD
OK0243480001OtherDMERC
OK0243480001Medicare NSC