Provider Demographics
NPI:1457367583
Name:WALKER-ARCHAMBO, DEBORAH SUZANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUZANNE
Last Name:WALKER-ARCHAMBO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:WALKER-ARCHAMBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:10215 WILLINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078
Mailing Address - Country:US
Mailing Address - Phone:704-892-4196
Mailing Address - Fax:
Practice Address - Street 1:323 SOUTH ARLINGTON STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-636-2494
Practice Address - Fax:704-636-5845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
093M8OtherBCBS
2470308DMedicare ID - Type Unspecified
U79732Medicare UPIN