Dr. Larry C Wallis, OD
Optometrist in Gloucester City, New Jersey
1821083585- Practice location
- 14 N Broadway, Gloucester City, NJ 08030-1507
- Phone
- 856-456-3925
- Fax
- 856-456-4748
- Last updated
- October 30, 2007
Larry Charles Wallis is an Optometrist based in Gloucester City, NJ. Larry Charles Wallis practices in Gloucester City, NJ and has the professional credentials of OD. The NPI Number for Larry Charles Wallis is 1821083585 and holds a License No. 270A00350300 (NJ). The current practice location address for Larry Charles Wallis is 14 N Broadway, Gloucester City, NJ 08030-1507 and can be reached out via phone at 856-456-3925 and via fax at 856-456-4748.
Provider Profile Details
- NPI Number
- 1821083585
- Provider Name
- Larry Charles Wallis
- Credential
- OD
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 14 N Broadway, Gloucester City, NJ 08030-1507
- Phone Number
- 856-456-3925
- Fax Number
- 856-456-4748
- Primary Taxonomy
- Optometrist · 152W00000X
- Sole Proprietor
- Yes
- Other Names
- Dr. Larry Charles Wallis (Other Name)
- Provider Enumeration Date
- September 19, 2005
- Last Update Date
- October 30, 2007
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 14 N Broadway
Gloucester City, NJ 08030-1507 - City
- Gloucester City
- State
- New Jersey
- Zip
- 08030-1507
- Phone Number
- 856-456-3925
- Fax Number
- 856-456-4748
Provider Business Mailing Address Details
- Address
- Po Box 93
14 N Broadway
Gloucester City, NJ 08030-0093 - City
- Gloucester City
- State
- NJ
- Zip
- 08030-0093
- Phone Number
- 856-456-3925
- Fax Number
- 856-456-4748
License Information
- License Number (1)
- 270A00350300
- License State (1)
- NJ
- Taxonomy (1)
- Optometrist · 152W00000X · Primary
- License Number (2)
- 27T000023300
- License State (2)
- NJ
- Taxonomy (2)
- Optometrist · 152W00000X
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Optometrists near Gloucester City, NJ
View all Optometrists in Gloucester City →- Dr. Larry Charles Wallis LLCOptometrist · NPI 1316382740
- Hannah Rosenthal, DNP, FNP-CNurse Practitioner, Family · NPI 1558024398
- Kathryn WesleySocial Worker, Clinical · NPI 1619338480
- Crowned CommunitiesCase Manager/Care Coordinator · NPI 1518878388
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- Mrs. Keana Fairfax, MSW, LCSWSocial Worker, Clinical · NPI 1588376891
Frequently Asked Questions
What is the NPI number of Dr. Larry C Wallis, OD?
The NPI number of Dr. Larry C Wallis, OD is 1821083585. It was assigned on September 19, 2005 and is currently active in the NPPES registry.
What is the specialty of Dr. Larry C Wallis, OD?
Dr. Larry C Wallis, OD is registered under the primary taxonomy Optometrist (code 152W00000X), licensed in NJ under license number 270A00350300.
Where does Dr. Larry C Wallis, OD practice?
The practice location is 14 N Broadway, Gloucester City, NJ 08030-1507. The office can be reached at 856-456-3925 (phone) or 856-456-4748 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1821083585 directly on the NPPES registry website.