Provider Demographics
NPI:1255595864
Name:WALKER, MATHEW THOMAS (OD)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:THOMAS
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 1:3101 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3162
Mailing Address - Country:US
Mailing Address - Phone:605-371-7100
Mailing Address - Fax:605-371-7199
Practice Address - Street 1:2600 JEFFERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3410
Practice Address - Country:US
Practice Address - Phone:320-762-2166
Practice Address - Fax:605-371-7199
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4394152W00000X
MN3146152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist