Organization
WALLACE OPTICIANS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK E WALLACE III (PRESIDENT)
(517) 332-8628
Entity
Organization
Contact information
Practice address
3040 VINE ST, LANSING, MI 48912
(517) 332-8628
(517) 332-5504
Mailing address
3040 VINE ST, LANSING, MI 48912
(517) 332-8628
(517) 332-5504
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900C36325
BCBS
MI
Enumeration date
10/25/2006
Last updated
08/22/2020
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