Basic Information
Provider Information | |||||||||
NPI: | 1558427948 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HUEYWALKER | ||||||||
FirstName: | DEBRA | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | OD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WALKER | ||||||||
OtherFirstName: | DEBRA | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | OD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2101 EAST JEFFERSON STREET | ||||||||
Address2: | PPQA MEDICARE COMPLIANCE UNIT 6 WEST | ||||||||
City: | ROCKVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 208524908 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3018166660 | ||||||||
FaxNumber: | 3018166308 | ||||||||
Practice Location | |||||||||
Address1: | 5999 BURKE COMMONS ROAD | ||||||||
Address2: |   | ||||||||
City: | BURKE | ||||||||
State: | VA | ||||||||
PostalCode: | 220152880 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7033835508 | ||||||||
FaxNumber: | 7032497847 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/29/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OP595 | DC | Y |   | Eye and Vision Services Providers | Optometrist |   |
No ID Information.