Provider Demographics
NPI:1437207040
Name:PARK RAPIDS WALKER EYE CLINIC OD PA
Entity type:Organization
Organization Name:PARK RAPIDS WALKER EYE CLINIC OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD - OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MURRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WESTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-732-3389
Mailing Address - Street 1:100 HUNTSINGER AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1326
Mailing Address - Country:US
Mailing Address - Phone:218-732-3389
Mailing Address - Fax:218-732-5994
Practice Address - Street 1:206 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1417
Practice Address - Country:US
Practice Address - Phone:218-732-3389
Practice Address - Fax:218-732-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN931088600Medicaid
MN931088600Medicaid
MNCP2427Medicare PIN
MN0516220001Medicare NSC