C Wallace Liles Jr Od Pa

NPI 1043438807 - Optometrist - 152W00000X

NPI Details
NPI 1043438807
Enumeration Date 04/24/2007
Last Updated 09/01/2009
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name C. WALLACE C.
Position DR.
Phone (479) 637-5598
Fax (479) 637-1195
Practice Location
72 W 2ND ST
WALDRON AR, 72958-7085, US
Phone (479) 637-5598
Fax (479) 637-1195
Business Location
72 W 2ND ST
WALDRON AR, 72958-7085, US
Phone (479) 637-5598
Fax (479) 637-1195
Toxanomy
Taxonomy Code 152W00000X
License State Arkansas
License Number AR2331
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According to our database, C Wallace Liles Jr Od Pa NPI is 1043438807, taxonomy code is 152W00000X and license number is AR2331, license state is located at Arkansas. C Wallace Liles Jr Od Pa physically located at 72 W 2nd St, Waldron AR, 72958-7085. NPI Number 1033115704 has the healthcare provider type.

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1043438807 NPI number is provided on an as is basis without warranty of any kind. 1043438807 is maintained by the National Plan & Provider Enumeration System. The contents of C Wallace Liles Jr Od Pa are for informational purposes only.