Organization
C. WALLACE LILES, JR OD PA
Active
Other names
LILES VISION CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. C. WALLACE LILES JR. O.D. (DR)
(479) 394-4215
Entity
Organization
Contact information
Practice address
703J HIGHWAY 71 N, MENA, AR 71953-4395
(479) 394-4215
Mailing address
703J HIGHWAY 71 N, MENA, AR 71953-4395
(479) 394-4215
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AR2331
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103836722
—
AR
Enumeration date
04/19/2007
Last updated
06/17/2009
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