Larry B Wallace, OD

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

VUT003212 Issued in NY

Practice address

322 N Aurora St
Ithaca, NY 14850-4202

Phone

(607) 277-4749

Fax

(607) 277-5216

NPI assigned

Jul 7, 2006

Last updated

Oct 6, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

New England College of Optometry, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Whole Picture Health and Vision LLCGroup PAC ID 7719217553, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tanya Sarah Bloom, OD

  • Vision Therapy Optometrist
  • Ithaca, NY
  • NPI 1144750035
  Medicare reassignment

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Whole Picture Health and Vision, LLC

  • Optometrist
  • Ithaca, NY
  • NPI 1609436542
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286323200000",
    "number": "1073545059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 N. AURORA ST.",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "14850",
            "telephone_number": "607-277-4749",
            "fax_number": "607-277-5216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 N AURORA ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504202",
            "telephone_number": "607-277-4749",
            "fax_number": "607-277-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LARRY",
        "middle_name": "B",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2010-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "NY",
            "license": "VUT003212",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "NY",
            "license": "VUT003212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE LICENSE",
            "identifier": "T003212-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #19684)
• Kristine M Walker, PT
• Tracy Walker
• Deborah Lynn Wallace-Ducharme, L.P.T.
• Georgiana Wallace
• Annette Fullmer Walluk, RN
• Anthony Walrath, PHARMD
• Tammy Sue Walrath, PA
• Emily M Walsh, LCAT, ATR
• Brett James Walters

• Vision Therapy Optometrist in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Vision Therapy Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.