C Wallace Liles Jr Od PA

NPI #1316165178 in De Queen, Arkansas

Provider Information

NPI Number: 1316165178
Entity Type: Organization
Organization Name: C Wallace Liles Jr Od PA
Primary Specialty: Optometrist
Enumeration Date: Apr 24, 2007
Last Updated: Sep 1, 2009

Practice Location

Address: 404D E COLLIN RAYE DR
City: De Queen
State: Arkansas
ZIP Code: 71832-4149
Phone: (870) 642-6900

Authorized Official

Name: DR. C. WALLACE LILES VI, O.D.
Title: DR.
Phone: (870) 642-6900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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