Individual
DR. JASON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
502 CELEBRATION AVE, CELEBRATION, FL 34747-4687
(407) 566-8505
(407) 566-8253
Mailing address
1921 VARICK WAY, CASSELBERRY, FL 32707-2410
(407) 637-9621
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC4182
FL
Other
Enumeration date
11/01/2006
Last updated
11/08/2017
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