Amwallace, LLC
Optometrist in Longview, TX. Organization (NPI-2).
NPI number1174802631
StatusActive
Last updated in NPPESMar 25, 2020
Details
- NPI
- 1174802631
- Entity type
- Organization (NPI-2)
- Legal business name
- Amwallace, LLC
- Organization subpart
- No
- Enumeration date
- Aug 15, 2011
- Certification date
- Mar 25, 2020
- Last updated
- Mar 25, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | T07660 | TX | Yes |
Other names
- August Wallace Eyecare Associates (Doing Business As)
- Texas State Optical Longview (Doing Business As)
Practice location
3032 N Eastman Rd Ste 100Longview, TX 75605-5024
Phone 903-663-2020 · Fax 903-663-2353
Mailing address
3032 N Eastman Rd Ste 100Longview, TX 75605-5024
Phone 903-663-2020 · Fax 903-663-2353
Authorized official
August Michael Wallace
Doctor/Owner
9036632020
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