Individual
JOHN W WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
4840 NORTHFIELD RD, NORTH RANDALL, OH 44128-4524
(216) 475-2160
(216) 475-2161
Mailing address
4840 NORTHFIELD RD, NORTH RANDALL, OH 44128-4524
(216) 475-2160
(216) 475-2161
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
6310S
OH
Other
Enumeration date
10/29/2015
Last updated
10/29/2015
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