Dennis Jaye Wallace, OD is a medicare enrolled "Optometrist" provider in Farmersville, California. His current practice location is
662 East Visalia Road, Farmersville, California. You can reach out to his office (for appointments etc.) via phone at
(559) 747-3461.
Dennis Jaye Wallace is licensed to practice in California (license number OPT5964 TPA) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1699741777.
Healthcare Provider's Profile
Full Name | Dennis Jaye Wallace |
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Gender | Male |
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Speciality | Optometrist |
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Location | 662 East Visalia Road, Farmersville, California |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1699741777
- Provider Enumeration Date: 02/27/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 2567434905
- Enrollment ID: I20040806001113
Medical Identifiers
Medical identifiers for Dennis Jaye Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1699741777 | NPI | - | NPPES |
2868614 | Other | CA | MEDICAL PASSWORD |
SD0059640 | Other | | BLUE SHIELD |
SD0059641 | Medicaid | CA | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
152W00000X | Optometrist | OPT5964 TPA (California) | Primary |
152W00000X | Optometrist | 406OPT TPA (Montana) | Secondary |
152W00000X | Optometrist | OD00001112 (Washington) | Secondary |
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. Dennis Jaye Wallace is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dennis Jaye Wallace, OD 662 East Visalia Road, Po Box 475, Farmersville, CA 93223-0475 Ph: (559) 747-3461 | Dennis Jaye Wallace, OD 662 East Visalia Road, Farmersville, CA 93223 Ph: (559) 747-3461 |
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