Wallace, Roy Trent

Wallace, Roy Trent is an individual health care provider with primary practice located at 345 23Rd Ave N Suite 350, Nashville TN 37203-1596. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Ophthalmology, Allopathic & Osteopathic Physicians / Retina Specialist. Allopathic & Osteopathic Physicians / Retina Specialist is his primary health care specialty. Wallace, Roy Trent can be contacted via phone (615) 983-6000.

Contact Information

Primary practice address
345 23Rd Ave N Suite 350 Nashville TN 37203-1596
Phone: (615) 983-6000
Fax: (615) 983-6010
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 30794 Kentucky
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X MD0000023587 Tennessee
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X MD0000023587 Tennessee

Profile Details

NPI number 1417946203
LBN Legal business name Wallace, Roy Trent
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 14th, 2005
Last updated Dec 1st, 2017 - about 7 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 1417946203 NPPES
Tennessee Other 3379053 MEDICARE/GROUP
Tennessee MEDICAID 64914617 MEDICARE/GROUP
Tennessee MEDICAID 3069202 MEDICARE/GROUP

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