Individual
DR. WALLACE M HANDELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4217 VIRGINIA BEACH BLVD, VIRGINIA BEACH, VA 23452-1232
(757) 340-7070
(757) 340-7500
Mailing address
4217 VIRGINIA BEACH BLVD, VIRGINIA BEACH, VA 23452-1232
(757) 340-7070
(757) 340-7500
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
601000770
VA
152WC0802X
Corneal and Contact Management Optometrist
601000770
VA
152WP0200X
Pediatric Optometrist
601000770
VA
152WX0102X
Occupational Vision Optometrist
601000770
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801903745
GROUP NPI
—
01
—
184237
ANTHEM BCBS
VA
01
—
51-0558604
TAXID CORP
—
05
—
92-3020-3
—
VA
Enumeration date
12/13/2005
Last updated
09/03/2008
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