Individual provider Active NPI

John Ward Walker, O.D.

  • Optometrist
  • Windsor, CA
National Provider Identifier
1871645978
Registry record updated Nov 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 10868 TPA Issued in CA
Practice address
9071 Conde LN
Windsor, CA 95492-7419
Phone
(707) 836-0306
Fax
(707) 836-0392
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 10868 TPA CA Primary

Addresses

Primary practice location

9071 Conde LN
Windsor, CA 95492-7419

Mailing address

9071 Conde LN
Windsor, CA 95492-7419
Phone (707) 836-0306

Other identifiers 1

IdentifierTypeStateIssuer
SD0108680MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20100728001227 CA Practitioner - Optometry 4688639602 Practice locations: Windsor, CA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9071 Conde LN
Windsor, CA 95492-7419
Phone (707) 836-0306

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383868800000",
    "number": "1871645978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9071 CONDE LN",
            "city": "WINDSOR",
            "state": "CA",
            "postal_code": "954927419",
            "telephone_number": "707-836-0306",
            "fax_number": "707-836-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9071 CONDE LN",
            "city": "WINDSOR",
            "state": "CA",
            "postal_code": "954927419",
            "telephone_number": "707-836-0306",
            "fax_number": "707-836-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "JOHN",
        "middle_name": "WARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2013-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 10868 TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0108680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, CA

Sources for this page

Verify at the official NPI Registry.