Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JOHN W WALLACE JR., LDO
Active Sole ProprietorJOHN W WALLACE JR., LDO is a Optician, Dispensing healthcare provider located in NORTH RANDALL, Ohio. NPI 1730551730 is currently active in the NPPES registry. Verify at CMS.
Optician, Dispensing · NORTH RANDALL, OH
Registration Details
- NPI Number
- 1730551730
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Oct 29, 2015 (10.770070728441 yrs)
- Last Updated
- Oct 29, 2015
- License
-
6310S (OH)
- Sole Proprietor
- Yes
Practice Information
- Address
-
4840 NORTHFIELD RDNORTH RANDALL, OH, 441284524Browse OH providers · Browse ZIP 44128
- Phone
- 2164752160
- Fax
- 2164752161
- Primary Specialty
-
Optician, Dispensing
156FX1800X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.