Wallis, Larry Charles
Wallis, Larry Charles is an sole proprietor health care provider with primary practice located at 14 N Broadway , Gloucester City NJ 08030-1507. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wallis, Larry Charles can be contacted via phone (856) 456-3925.Contact Information
Primary practice address
14 N Broadway
Gloucester City NJ 08030-1507
Phone: (856) 456-3925
Fax: (856) 456-4748
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 270A00350300 | New Jersey |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 27T000023300 | New Jersey |
Profile Details
| NPI number | 1821083585 |
|---|---|
| LBN Legal business name | Wallis, Larry Charles |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 19th, 2005 |
| Last updated | Oct 30th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821083585 | NPPES |
| New Jersey | MEDICAID | 1695401 |
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