Larry B Wallace OD

NPI 1073545059 - Optometrist - 152WL0500X

NPI Details
NPI 1073545059
Gender Male
Enumeration Date 07/07/2006
Last Updated 10/06/2010
Entity Type Individual
Active Over 10 years ago
Practice Location
322 N AURORA ST
ITHACA NY, 14850-4202, US
Phone (607) 277-4749
Fax (607) 277-5216
Business Location
322 N. AURORA ST.
ITHACA NY, 14850, US
Phone (607) 277-4749
Fax (607) 277-5216
Toxanomy
Taxonomy Code 152WL0500X
License State New York
License Number VUT003212
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According to our database, Larry B Wallace OD NPI is 1073545059, taxonomy code is 152WL0500X and license number is VUT003212, license state is located at New York. Larry B Wallace OD physically located at 322 N Aurora St, Ithaca NY, 14850-4202. NPI Number Larry B Wallace OD has the Individual type.

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1073545059 NPI number is provided on an as is basis without warranty of any kind. 1073545059 is maintained by the National Plan & Provider Enumeration System. The contents of Larry B Wallace OD are for informational purposes only.