Individual
DR. AUGUST MICHAEL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3032 N EASTMAN RD STE 100, LONGVIEW, TX 75605-5024
(903) 663-2020
(903) 663-2353
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7660
TX
Other
Enumeration date
06/27/2007
Last updated
09/20/2021
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