Individual provider Active NPI

Donald Walker, OD

  • Optometrist
  • Shreveport, LA
National Provider Identifier
1386639110
Registry record updated Dec 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
809097T Issued in LA
Practice address
6823 Pines Rd
Suite B
Shreveport, LA 71129-5205
Phone
(318) 688-3050
Fax
(318) 688-3233
NPI assigned
Sep 19, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 809097T LA Primary
Eyewear Supplier 332H00000X 152W00000X LA

Addresses

Primary practice location

6823 Pines Rd
Suite B
Shreveport, LA 71129-5205

Mailing address

6823 Pines Rd
Suite B
Shreveport, LA 71129-5205
Phone (318) 688-3050

Other identifiers 1

IdentifierTypeStateIssuer
1342696MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040608000595 LA Practitioner - Optometry 3870576267 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
809097TLAMDOptometrist
152W00000XLAMDEyewear Supplier

Practice roles

OrganizationSpecialtyStatusNew patients
Lusk Eye Specialists, LLC Optometrist CurrentSince Mar 1, 2016 Accepting new patients

Locations

451 Ashley Ridge Blvd
Shreveport, LA 71106
Phone (318) 222-5555

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229385600000",
    "number": "1386639110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6823 PINES RD",
            "address_2": "SUITE B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711295205",
            "telephone_number": "318-688-3050",
            "fax_number": "318-688-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6823 PINES RD",
            "address_2": "SUITE B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711295205",
            "telephone_number": "318-688-3050",
            "fax_number": "318-688-3233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "DONALD",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2008-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "809097T",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "LA",
            "license": "152W00000X",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1342696",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.