| NPI | 1831152800 |
|---|---|
| Doing Business As | WALLACE OPTICAL SHOP |
| Entity Type | Organization |
| Authorized Contact | GAIL NANETTE BRYANT Business Manger 501-624-0609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2008-06-12 |