Wallissa Lancelin, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9812TG Issued in TX

Practice address

5700 Overton Ridge Blvd
Fort Worth, TX 76132-3220

Phone

(817) 668-6852

NPI assigned

Aug 5, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697932800000",
    "number": "1093269284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 TOBIANO TRCE",
            "city": "BROCK",
            "state": "TX",
            "postal_code": "760876748",
            "telephone_number": "337-578-1830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 OVERTON RIDGE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761323220",
            "telephone_number": "817-668-6852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANCELIN",
        "first_name": "WALLISSA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-05",
        "last_updated": "2023-10-22",
        "certification_date": "2023-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1819-753AT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9812TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Lynn Lancaster, PTA
• Kamie Lancaster, OT
• Christian Ann Lance, M.D.
• Kayla Lance, LPC
• Lisa Marie Lance, R.N.
• Alexia Lanctot-Corpuz
• Tory William Lanctot, LMT
• Natalie Land, M.S., LMFT-S
• Richard A Landers, OD
• Courtney Landes, LCSW

• Optometrist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.