Provider Demographics
NPI:1871559575
Name:WALKER, LISA ANN (OD OPTOMETRY)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:OD OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-4752
Mailing Address - Country:US
Mailing Address - Phone:580-243-2020
Mailing Address - Fax:580-243-2040
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4752
Practice Address - Country:US
Practice Address - Phone:580-243-2020
Practice Address - Fax:580-243-2040
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U11166Medicare UPIN
OK0195060001Medicare NSC