Dr. Larry Charles Wallis LLC

NPI #1316382740 in Gloucester City, New Jersey

Provider Information

NPI Number
1316382740
Entity Type
Organization
Organization Name
Dr. Larry Charles Wallis LLC
Primary Specialty
Optometrist
Enumeration Date
Apr 29, 2013
Last Updated
Apr 29, 2013

Practice Location

Address
14 N BROADWAY
Address 2
POB93
ZIP Code
08030-1507
Phone
(856) 456-3925

Authorized Official

Name
DR. LARRY CHARLES WALLIS, O.D.
Title
OWNER-OPTOMETRIST
Phone
(856) 456-3925

Specialties & Taxonomy Codes

Specialty
Optometrist

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