Duane J Wallaker OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1294 Issued in MN

Legal business name

DUANE J WALLAKER OD

Practice address

510 W Oakland Ave
Box 524
Austin, MN 55912-2314

Phone

(507) 437-4524

Fax

(507) 437-4525

NPI assigned

Sep 15, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Duane J Wallaker, OD

Title

Owner

Phone

(507) 437-4524

Specialties & licenses 1

Addresses

Other identifiers 7

Locations

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1487649489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 W OAKLAND AVE",
            "address_2": "BOX 524",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559122314",
            "telephone_number": "507-437-4524",
            "fax_number": "507-437-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 W OAKLAND AVE",
            "address_2": "BOX 524",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559122314",
            "telephone_number": "507-437-4524",
            "fax_number": "507-437-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUANE J WALLAKER OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "WALLAKER",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-437-4524",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MN",
            "identifier": "16412",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMERC",
            "identifier": "0182820001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN CARE",
            "identifier": "4C955WA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2292129",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "703023100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "32549WA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREF ONE",
            "identifier": "585541034950",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Shirley Dowell, D.O.
• Draayer Chiropractic, Inc.
• Patrick Arthur Draayer, D.C.
• Jennifer T Dreyer, LPN
• DRS Elrod Green DDS PA
• Cynthia Marie Dube, M.D.
• Todd J Dube
• Jose R Duenes
• Erin Nicole Dankert Eggum, DO, MHA
• Kristen Ehmke

• Optometrist in Austin, MN
• Providers in Austin, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.