Allan M Wallace, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2898TG Issued in TX

Practice address

11803 South Frwy
Suite 114
Fort Worth, TX 76115

Phone

(817) 551-5600

NPI assigned

Aug 2, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225045164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 STEAMBOAT CT",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760063761",
            "telephone_number": "817-551-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11803 SOUTH FRWY",
            "address_2": "SUITE 114",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76115",
            "telephone_number": "817-551-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALLAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2898TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00E37E",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Lawrence Walker, DO
• Torrance Anthony Walker, M.D.
• Aaron Lee Wall, D.C.
• Keaton Wall
• Krista Wall, SLP
• Angela Webb Wallace, OTR
• Ashley Lynette Wallace, MSN, APRN, FNP-C,
• Bethany Wallace, LCSW
• Cristy L Wallace, FNP
• Gabriel Wallace

• 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 Jul 8, 2007; 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.