Organization
C WALLACE LILES JR OD PA
Active
Other names
Liles Vision Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. C. WALLACE LILES JR. O.D. (DR.)
(479) 637-5598
Entity
Organization
Contact information
Practice address
72 W 2ND ST, WALDRON, AR 72958-7085
(479) 637-5598
(479) 637-1195
Mailing address
72 W 2ND ST, WALDRON, AR 72958-7085
(479) 637-5598
(479) 637-1195
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AR2331
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125850722
—
AR
Enumeration date
04/24/2007
Last updated
09/01/2009
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