Organization
CHRIS WALLACE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER SHAWN WALLACE O.D. (PRESIDENT)
(206) 419-7400
Entity
Organization
Contact information
Practice address
8624-202ND STREET SW, EDMONDS, WA 98026-6644
(206) 419-7400
Mailing address
8624-202ND STREET SW, EDMONDS, WA 98026-6644
(206) 419-7400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD 00003752
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OD 5342
—
AK
Enumeration date
07/16/2009
Last updated
07/16/2009
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