C Wallace Liles Jr Od Pa is a
Optometrist based in Waldron, Arkansas. C Wallace Liles Jr Od Pa is licensed to practice in Arkansas (license number AR2331) and their current practice location is
72 W 2nd St, Waldron, Arkansas. It can be reached at their office (for appointments etc.) via phone at
(479) 637-5598.
NPI number for C Wallace Liles Jr Od Pa is 1043438807 and their current mailing address is 72 W 2nd St, Waldron, Arkansas. C Wallace Liles Jr Od Pa
does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1043438807.
Healthcare Provider's Profile
| Full Name | C Wallace Liles Jr Od Pa |
|---|
| Type | Facility |
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| Speciality | Optometrist |
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| Location | 72 W 2nd St, Waldron, Arkansas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1043438807
- Provider Enumeration Date: 04/24/2007
- Last Update Date: 09/01/2009
Medical Identifiers
Medical identifiers for C Wallace Liles Jr Od Pa such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1043438807 | NPI | - | NPPES |
| 125850722 | Medicaid | AR | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | AR2331 (Arkansas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. C Wallace Liles Jr Od Pa is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
C Wallace Liles Jr Od Pa
72 W 2nd St,
Waldron, AR 72958-7085
Ph: (479) 637-5598 | C Wallace Liles Jr Od Pa
72 W 2nd St,
Waldron, AR 72958-7085
Ph: (479) 637-5598 |
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