August M Wallace Enterprises, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1483 Issued in SC

Legal business name

AUGUST M WALLACE ENTERPRISES, LLC

Doing business as

Wallace Vision Center

Practice address

805 Highway 9 Byp W
Lancaster, SC 29720

Phone

(803) 286-4836

NPI assigned

Dec 21, 2010

Last updated

Dec 21, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. August M Wallace, OD

Title

Owner

Phone

(803) 201-8526

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wallace Vision Center Doing business as

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

{
    "created_epoch": "1292889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292889600000",
    "number": "1114220738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 HIGHWAY 9 BYP W",
            "city": "LANCASTER",
            "state": "SC",
            "postal_code": "29720",
            "telephone_number": "803-286-4836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 HIGHWAY 9 BYP W",
            "city": "LANCASTER",
            "state": "SC",
            "postal_code": "29720",
            "telephone_number": "803-286-4836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUST M WALLACE ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-21",
        "last_updated": "2010-12-21",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "AUGUST",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-201-8526",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D14839",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wallace Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Lancaster, SC
• Providers in Lancaster, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; 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.