Individual
DR. WHITNEY MORGAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
724 E BOUGHTON RD, BOLINGBROOK, IL 60440-2279
(630) 633-5631
Mailing address
21 SPINNING WHEEL RD APT 6B, HINSDALE, IL 60521-7639
(207) 730-9391
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046011612
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046011612
IL LICENSE NUMBER
IL
Enumeration date
06/02/2022
Last updated
06/02/2022
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