Individual
KIRK D WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.D.O.
Contact information
Practice address
44407 10TH ST W, LANCASTER, CA 93534-3345
(661) 942-6515
(661) 723-9293
Mailing address
44407 10TH ST W, LANCASTER, CA 93534-3345
(661) 942-6515
(661) 723-9293
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
6273
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ35826Z
—
CA
Enumeration date
02/21/2007
Last updated
09/18/2012
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