Organization
MOLALLA VISION CLINIC PC
Active
Parent organization
J. WALLACE WALKER OD
Organization subpart
Yes
Provider details
NPI number
Legal business name
J. WALLACE WALKER OD
Authorized official
MR. JAY WALLACE WALKER OD (OWNER)
(503) 829-9186
Entity
Organization
Contact information
Practice address
502 E MAIN ST, MOLALLA, OR 97038-9148
(503) 829-9186
(503) 829-8402
Mailing address
PO BOX 480, MOLALLA, OR 97038-0480
(503) 829-9186
(503) 829-8402
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2487ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260661
—
OR
Enumeration date
01/14/2008
Last updated
05/11/2009
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