C Wallace Liles III O D LLC

NPI #1376948687 in De Queen, Arkansas

Provider Information

NPI Number: 1376948687
Entity Type: Organization
Organization Name: C Wallace Liles III O D LLC
Primary Specialty: Optometrist
Enumeration Date: Oct 29, 2014
Last Updated: Oct 29, 2014

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 III, OD
Title: OWNER
Phone: (479) 394-4215

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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