Organization
OPTIMUM FOOT CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERNEST H WALLACE (OWNER-PRESIDENT)
(757) 503-2196
Entity
Organization
Contact information
Practice address
8000 IH 10 W, SUITE 600, SAN ANTONIO, TX 78230-3802
(210) 417-5353
Mailing address
4836 WALTERS CIR, UNIT A, FORT SILL, OK 73503-5010
(580) 574-8414
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
07/23/2013
Last updated
08/08/2013
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