Provider Demographics
NPI:1952425704
Name:WALKER, CARMEN LYNN
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 CARLISLE PIKE
Mailing Address - Street 2:HAMPDEN OPTICAL
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3098
Mailing Address - Country:US
Mailing Address - Phone:717-761-2295
Mailing Address - Fax:717-761-8123
Practice Address - Street 1:4900 CARLISLE PIKE
Practice Address - Street 2:HAMPDEN OPTICAL
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3098
Practice Address - Country:US
Practice Address - Phone:717-761-2295
Practice Address - Fax:717-761-8123
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3902840001Medicare PIN