Organization
DUANE J WALLAKER OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUANE J WALLAKER OD (OWNER)
(507) 437-4524
Entity
Organization
Contact information
Practice address
510 W OAKLAND AVE, BOX 524, AUSTIN, MN 55912-2314
(507) 437-4524
(507) 437-4525
Mailing address
510 W OAKLAND AVE, BOX 524, AUSTIN, MN 55912-2314
(507) 437-4524
(507) 437-4525
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1294
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0182820001
OMERC
—
01
—
16412
UCARE MN
—
01
—
2292129
MEDICA
—
01
—
32549WA
BLUE CROSS
MN
01
—
4C955WA
MN CARE
MN
01
—
585541034950
PREF ONE
—
05
—
703023100
—
MN
Enumeration date
09/15/2005
Last updated
03/31/2008
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