C Wallace Liles Iii O D Llc

NPI 1134524770 - Optometrist - 152W00000X

NPI Details
NPI 1134524770
Enumeration Date 10/24/2014
Last Updated 10/24/2014
Entity Type Healthcare Provider
Active Over 2 years ago
Authorized Information
Name C WALLACE C
Position OWNER
Phone (479) 394-4215
Fax (479) 394-3455
Practice Location
703 HIGHWAY 71 N STE J
MENA AR, 71953-4341, US
Phone (479) 394-4215
Fax (479) 394-3455
Business Location
703 HIGHWAY 71 N STE J
MENA AR, 71953-4341, US
Phone (479) 394-4215
Fax (479) 394-3455
Toxanomy
Taxonomy Code 152W00000X
License State Arkansas
License Number 2331
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According to our database, C Wallace Liles Iii O D Llc NPI is 1134524770, taxonomy code is 152W00000X and license number is 2331, license state is located at Arkansas. C Wallace Liles Iii O D Llc physically located at 703 Highway 71 N Ste J, Mena AR, 71953-4341. NPI Number 1033115704 has the healthcare provider type.

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1134524770 NPI number is provided on an as is basis without warranty of any kind. 1134524770 is maintained by the National Plan & Provider Enumeration System. The contents of C Wallace Liles Iii O D Llc are for informational purposes only.