Organization
APPLE VALLEY FAMILY OPTOMETRY CENTRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN BRUCE WALLIS O.D. (DOCTOR)
(760) 946-2700
Entity
Organization
Contact information
Practice address
15972 TUSCOLA RD, SUITE 101, APPLE VALLEY, CA 92307-2106
(760) 946-2700
(760) 946-3355
Mailing address
15972 TUSCOLA RD, SUITE 101, APPLE VALLEY, CA 92307-2106
(760) 946-2700
(760) 946-3355
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7082T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0070820
—
CA
01
—
ZZZ05917Z
MEDICARE PTAN
CA
01
—
ZZZ58328Z
BLUE SHIELD
CA
Enumeration date
03/08/2007
Last updated
08/06/2009
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