Individual
DR. FRED WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1431 2ND AVE N, BESSEMER, AL 35020-5608
(205) 425-5182
(205) 426-5013
Mailing address
1431 2ND AVE N, BESSEMER, AL 35020-5608
(205) 425-5182
(205) 426-5013
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-517-TA-090
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059719
—
AL
01
—
051059719
BLUE CROSS
AL
01
—
P00077951
RAILROAD
AL
Enumeration date
09/14/2006
Last updated
06/02/2010
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