Provider Demographics
NPI:1679533137
Name:WALKER, JULIENNE ANTIONETTE (OD)
Entity type:Individual
Prefix:DR
First Name:JULIENNE
Middle Name:ANTIONETTE
Last Name:WALKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 E WESTFIELD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2084
Mailing Address - Country:US
Mailing Address - Phone:908-445-8687
Mailing Address - Fax:908-259-5191
Practice Address - Street 1:236 E WESTFIELD AVE STE 104
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2084
Practice Address - Country:US
Practice Address - Phone:908-445-8687
Practice Address - Fax:908-259-5191
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005881152W00000X
NJ27OA00645700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01782214Medicaid
NJ0513466Medicaid
NYA400005393Medicare PIN
NJC39091Medicare UPIN