Wallace, Christopher Shawn

Wallace, Christopher Shawn is an individual health care provider with primary practice located at 8745 Glacier Hwy Space 426, Juneau AK 99801-8029. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wallace, Christopher Shawn can be contacted via phone (907) 796-3937.

Contact Information

Primary practice address
8745 Glacier Hwy Space 426 Juneau AK 99801-8029
Phone: (907) 796-3937
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X AK 201 Alaska
Eye and Vision Services Providers / Optometrist 152W00000X OD3752WA Washington

Profile Details

NPI number 1790859528
LBN Legal business name Wallace, Christopher Shawn
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 20th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790859528 NPPES
Alaska MEDICAID OD 5342

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