Individual
DR. JAMES WINCHESTER WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1450 E GENEVA ST, DELAVAN, WI 53115-2025
(262) 728-0068
(262) 728-0055
Mailing address
1450 E GENEVA ST, DELAVAN, WI 53115-2025
(262) 728-0068
(262) 728-0055
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2267
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3857500
—
WI
Enumeration date
06/08/2006
Last updated
07/08/2007
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