Provider Demographics
NPI:1982265765
Name:WALKOWIAK, AMY LYNN (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:WALKOWIAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 BURNING TREE RD STE 311
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1876
Mailing Address - Country:US
Mailing Address - Phone:218-481-6027
Mailing Address - Fax:
Practice Address - Street 1:5115 BURNING TREE RD STE 311
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1876
Practice Address - Country:US
Practice Address - Phone:218-481-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist