Provider Demographics
NPI:1881700078
Name:WALKER, KAREN TRAYLOR (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:TRAYLOR
Last Name:WALKER
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:PO BOX 2599
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85380-2599
Mailing Address - Country:US
Mailing Address - Phone:623-451-8982
Mailing Address - Fax:623-236-9648
Practice Address - Street 1:8613 W MALAPAI DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-3102
Practice Address - Country:US
Practice Address - Phone:623-451-8982
Practice Address - Fax:623-236-9648
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2399152W00000X
AZ1589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ235824Medicaid
AZZ122269Medicare PIN
ARU22806Medicare UPIN