Dr Larry Charles Wallis, OD is a
Optometrist based in Gloucester City, New Jersey. Dr Larry Charles Wallis is licensed to practice in New Jersey (license number 270A00350300) and his current practice location is
14 N Broadway, Gloucester City, New Jersey. He can be reached at his office (for appointments etc.) via phone at
(856) 456-3925.
NPI number for Dr Larry Charles Wallis is 1821083585 and his current mailing address is Po Box 93, 14 N Broadway, Gloucester City, New Jersey. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1821083585.
Healthcare Provider's Profile
| Full Name | Dr Larry Charles Wallis |
|---|
| Gender | Male |
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| Speciality | Optometrist |
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| Location | 14 N Broadway, Gloucester City, New Jersey |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1821083585
- Provider Enumeration Date: 09/19/2005
- Last Update Date: 10/30/2007
Medical Identifiers
Medical identifiers for Dr Larry Charles Wallis such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1821083585 | NPI | - | NPPES |
| 1695401 | Medicaid | NJ | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | 270A00350300 (New Jersey) | Primary |
| 152W00000X | Optometrist | 27T000023300 (New Jersey) | 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. Dr Larry Charles Wallis 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 |
|---|
Dr Larry Charles Wallis, OD
Po Box 93, 14 N Broadway,
Gloucester City, NJ 08030-0093
Ph: (856) 456-3925 | Dr Larry Charles Wallis, OD
14 N Broadway,
Gloucester City, NJ 08030-1507
Ph: (856) 456-3925 |
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