Individual
MRS. TAMMY D. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1234 ANDREWS AVE, SUITE E, OZARK, AL 36360-3767
(334) 445-3937
(334) 445-3938
Mailing address
1234 ANDREWS AVE, SUITE E, OZARK, AL 36360-3767
(334) 445-3937
(334) 445-3938
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-C02
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157145
—
AL
Enumeration date
06/11/2009
Last updated
07/02/2015
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