Individual
DR. DAVID WALLACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
16820 JAMAICA AVE, JAMAICA, NY 11432-5216
(718) 739-5454
(718) 526-1818
Mailing address
6939 173RD ST, FLUSHING, NY 11365-3432
(718) 739-5454
(718) 526-1818
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV004825
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01178821
—
NY
Enumeration date
05/10/2007
Last updated
07/08/2007
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