C Wallace Liles III O D LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2331 Issued in AR

Legal business name

C WALLACE LILES III O D LLC

Practice address

703 Highway 71 N Ste J
Mena, AR 71953-4341

Phone

(479) 394-4215

Fax

(479) 394-3455

NPI assigned

Oct 24, 2014

Last updated

Oct 24, 2014By 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. C Wallace Liles III, OD

Title

Owner

Phone

(479) 394-4215

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414108800000",
    "number": "1134524770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 HIGHWAY 71 N STE J",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719534341",
            "telephone_number": "479-394-4215",
            "fax_number": "479-394-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 HIGHWAY 71 N STE J",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719534341",
            "telephone_number": "479-394-4215",
            "fax_number": "479-394-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C WALLACE LILES III O D LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-24",
        "last_updated": "2014-10-24",
        "status": "A",
        "authorized_official_last_name": "LILES",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "WALLACE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-394-4215",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Douglas Buckley Jr., PT,,DPT
• Kaitlyn Bunch, M.S. CF-SLP
• Anthony R. Burton, M.D.
• Buschman Internal Medicine PLLC
• Paul Benjamin Buschman II, MD
• C. Wallace Liles, Jr OD PA (Liles Vision Clinic)
• Ann E. Calandro, PHARM.D.
• Jerold Benjamin Campbell, CRNA
• Tonya L Chambers, PMHNP
• Lane Myles Cheramie, RPH

• Optometrist in Mena, AR
• Providers in Mena, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; 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.