Provider Demographics
NPI:1902806375
Name:WALKER, DOUGLAS JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOHN
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 1:937 CHETCO AVE STE K4005
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0228
Mailing Address - Country:US
Mailing Address - Phone:541-469-6923
Mailing Address - Fax:541-469-6769
Practice Address - Street 1:937 CHETCO AVE STE K 4005
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415
Practice Address - Country:US
Practice Address - Phone:541-469-6923
Practice Address - Fax:541-469-6769
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 2740-AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2083170Medicaid
ORR113489OtherMEDICARE GROUP PIN
OR1072650Medicare ID - Type Unspecified
OR2083170Medicaid
U806910Medicare UPIN