Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC1124 | FL |
NPI | 1003993122 |
---|---|
Provider Name | Dr. R. Scott Walker |
First Address | Venice, FL 34285-2301 |
Second Address | Venice, FL 34285-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 05/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T84030 | (02) | FL |