DR. Larry Charles Wallis, OD

NPI #1821083585 in Gloucester City, New Jersey

Provider Information

NPI Number
1821083585
Entity Type
Individual
Name
DR. Larry Charles Wallis, OD
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Optometrist
Credential
OD
Enumeration Date
Sep 19, 2005
Last Updated
Oct 30, 2007

Practice Location

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

Specialties & Taxonomy Codes

Specialty
Optometrist

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Organizations

Provider Name
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