Individual
DR. RONALD CHARLES WALLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
115 W BROAD ST, SUITE A, NEWTON FALLS, OH 44444-1572
(330) 872-1371
(330) 872-1248
Mailing address
115 W BROAD ST, SUITE A, NEWTON FALLS, OH 44444-1572
(330) 872-1371
(330) 872-1248
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3576/T1280
OH
152WC0802X
Corneal and Contact Management Optometrist
3576/T1280
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0481072
—
OH
Enumeration date
05/18/2006
Last updated
02/09/2010
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