Provider Demographics
NPI:1487607248
Name:WALKER, DIANE L (OD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:705 S UNIVERSITY AVE
Mailing Address - Street 2:STE 510
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3081
Mailing Address - Country:US
Mailing Address - Phone:920-885-8551
Mailing Address - Fax:920-885-8565
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2237
Practice Address - Country:US
Practice Address - Phone:608-647-8995
Practice Address - Fax:608-647-2569
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2570-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38591400Medicaid
WI8070OtherDEAN HEALTH INSURANCE
WI1006556OtherPHYSICIANS PLUS
WI8070OtherDEAN HEALTH INSURANCE