Organization
C WALLACE LILES III O D LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. C WALLACE LILES III OD (OWNER)
(479) 394-4215
Entity
Organization
Contact information
Practice address
703 HIGHWAY 71 N STE J, MENA, AR 71953-4341
(479) 394-4215
(479) 394-3455
Mailing address
703 HIGHWAY 71 N STE J, MENA, AR 71953-4341
(479) 394-4215
(479) 394-3455
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2331
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181897722
—
AR
Enumeration date
10/24/2014
Last updated
10/24/2014
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