Individual
DR. ALLAN M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
11803 SOUTH FRWY, SUITE 114, FORT WORTH, TX 76115
(817) 551-5600
Mailing address
605 STEAMBOAT CT, ARLINGTON, TX 76006-3761
(817) 551-5600
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2898TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00E37E
BCBS
TX
Enumeration date
08/02/2006
Last updated
07/08/2007
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