Organization
AUGUST M WALLACE ENTERPRISES, LLC
Active
Other names
Wallace Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUGUST M WALLACE OD (OWNER)
(803) 201-8526
Entity
Organization
Contact information
Practice address
805 HIGHWAY 9 BYP W, LANCASTER, SC 29720
(803) 286-4836
Mailing address
805 HIGHWAY 9 BYP W, LANCASTER, SC 29720
(803) 286-4836
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1483
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D14839
—
SC
Enumeration date
12/21/2010
Last updated
12/21/2010
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