Donald W Wallace

Primary specialty

Hearing Instrument SpecialistTaxonomy code 237700000X

License

3320 Issued in IL

Practice address

3003 Pershing CT Ste 101
Decatur, IL 62526-6323

Phone

(217) 330-9654

NPI assigned

Sep 20, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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": "1379635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1467888537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3113 FLINTLOCK PATH",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633013902",
            "telephone_number": "314-761-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 PERSHING CT STE 101",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625266323",
            "telephone_number": "217-330-9654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DONALD",
        "middle_name": "W",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-09-20",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "MO",
            "license": "2013004501",
            "primary": false
        },
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "IL",
            "license": "3320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEARING AID DISPENSER LICENSE",
            "identifier": "2013004501",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEARING AID DISPENSER LICENCE",
            "identifier": "3320",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co.
• Kimberly Walker, MD
• Nikki Walker, LPC
• Terri Noonan Walker, L.C.S.W.
• Michelle Kathryn Wall
• Sara S Wallis, AGACNP
• Walmart Inc.
• Walmart Inc.
• Jessica E Walston, PHARMD
• Kelly R Walter

• Hearing Instrument Specialist in Decatur, IL
• Providers in Decatur, IL by specialty
• Hearing Instrument Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; 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.