C. Wallace Liles Jr., O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

AR2331 Issued in AR

Practice address

208 Morrow St S
Mena, AR 71953-2510

Phone

(479) 394-4215

Fax

(479) 394-3455

NPI assigned

Jun 24, 2005

Last updated

Jun 3, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Dr. Perry Lee Amerine, PA

  • Optometrist
  • Little Rock, AR
  • NPI 1427370022
  Medicare reassignment NPD
• Med Southwest, PLLC

  dba MyEyeDr.

  • Optometrist
  • Arkadelphia, AR
  • NPI 1497211783
  Medicare reassignment NPD
• C Wallace Liles Jr OD PA

  • Optometrist
  • Waldron, AR
  • NPI 1043438807
  NPD (past) Authorized official
• C Wallace Liles Jr OD PA

  dba Liles Vision Clinic

  • Optometrist
  • De Queen, AR
  • NPI 1316165178
  NPD (past) Authorized official
• C. Wallace Liles, Jr OD PA

  dba Liles Vision Clinic

  • Optometrist
  • Mena, AR
  • NPI 1275750606
  Authorized official Same address or phone
• Med Southwest, PLLC

  dba MyEyeDr.

  • Optometrist
  • Mena, AR
  • NPI 1467918763
  NPD
• Med Southwest, PLLC

  • Optometrist
  • Oklahoma City, OK
  • NPI 1679440762
  NPD

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1184620049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703J HIGHWAY 71 N",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719534395",
            "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": "208 MORROW ST S",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719532510",
            "telephone_number": "479-394-4215",
            "fax_number": "479-394-3455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "703J Highway 71 N",
            "address_purpose": "LOCATION",
            "city": "Mena",
            "state": "AR",
            "postal_code": "719534395",
            "country_code": "US",
            "telephone_number": "479-394-4215",
            "fax_number": "479-394-3455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LILES",
        "first_name": "C.",
        "middle_name": "WALLACE",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "AR2331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103836722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julianna Elyse Kiser, MS
• David L Koppein Jr., NP
• Heather Lackey, QBHP
• Kristen K Ledbetter
• Zoe Ledbetter, PHARMD
• Little Rock Vamc
• Richard Mark Lochala, M.D.
• Mary Beth Lowery, LCSW
• Robert Manis, M.D.
• Diane Marosy, DDS

• 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 Jun 3, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.