Organization
EYE SURGICAL ASSOCIATES P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN KENNETH WALLACE MD (PRESIDENT)
(334) 699-2244
Entity
Organization
Contact information
Practice address
2664 HARTFORD HWY, DOTHAN, AL 36305-4904
(334) 699-2244
(334) 699-2245
Mailing address
2664 HARTFORD HWY, DOTHAN, AL 36305-4904
(334) 699-2244
(334) 699-2245
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
13178
AL
Other
Enumeration date
05/07/2008
Last updated
11/17/2011
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