Individual
DR. ROBERT BRIAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2014 S IRBY ST, FLORENCE, SC 29505-3420
(843) 679-9005
Mailing address
1305 MADISON AVE, FLORENCE, SC 29501-4528
(843) 661-5063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
SC1088
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D10888
—
SC
Enumeration date
06/14/2006
Last updated
07/08/2007
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