Individual
MR. JAY WALLACE WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
502 E MAIN STREET, MOLALLA, OR 97038
(503) 829-9186
(503) 829-8402
Mailing address
PO BOX 480, MOLALLA, OR 97038
(503) 829-9186
(503) 829-8402
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2487ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260661
—
OR
Enumeration date
09/01/2006
Last updated
06/30/2023
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