Individual
DR. CHRISTOPHER SHAWN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
8745 GLACIER HWY, SPACE 426, JUNEAU, AK 99801-8029
(907) 796-3937
Mailing address
8624 202ND ST SW, EDMONDS, WA 98026-6644
(206) 419-7400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AK 201
AK
152W00000X
Optometrist
OD3752WA
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OD 5342
—
AK
Enumeration date
11/20/2006
Last updated
07/08/2007
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