Organization
WALLACE EYE SURGERY, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT BRUCE WALLACE III MD (MEDICAL DIRECTOR)
(318) 448-4488
Entity
Organization
Contact information
Practice address
4110 PARLIAMENT DR, ALEXANDRIA, LA 71303-2717
(318) 448-4488
(318) 448-9731
Mailing address
4110 PARLIAMENT DR, ALEXANDRIA, LA 71303-2717
(318) 448-4488
(318) 448-9731
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
012846
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942006
—
LA
Enumeration date
06/02/2006
Last updated
08/22/2020
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