Individual
LACEY LEANN WALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
10 LINCOLN HWY STE 101, FAIRVIEW HEIGHTS, IL 62208-2100
(618) 624-0222
(618) 624-4930
Mailing address
15933 CLAYTON RD, SUITE 201, BALLWIN, MO 63011-2172
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0406010739
IL
Other
Enumeration date
09/12/2013
Last updated
03/21/2017
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