Fred Wallace, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

S-517-TA-090 Issued in AL

Practice address

1431 2ND Ave N
Bessemer, AL 35020-5608

Phone

(205) 425-5182

Fax

(205) 426-5013

NPI assigned

Sep 14, 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 3

Medicare fee-for-service enrollment

Enrolled in AL

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

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.

• Wallace Optometry Associates

  • Optometrist
  • Bessemer, AL
  • NPI 1245307032
  Authorized official Same address or phone

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275436800000",
    "number": "1497850085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 2ND AVE N",
            "city": "BESSEMER",
            "state": "AL",
            "postal_code": "350205608",
            "telephone_number": "205-425-5182",
            "fax_number": "205-426-5013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 2ND AVE N",
            "city": "BESSEMER",
            "state": "AL",
            "postal_code": "350205608",
            "telephone_number": "205-425-5182",
            "fax_number": "205-426-5013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "FRED",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2010-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-517-TA-090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051059719",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000059719",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00077951",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matalie Walker
• Charles Ray Wall, RPH
• William M Wall, MD
• Wallace Optometry Associates
• Alana Wallace, PTA
• Amber Elaine Walls, CRNP
• Walmart Pharmacy 10 0764
• Philecia R Ward
• Lonnie Anthony Washington
• Nicholas Benjamin Washmuth, DPT

• Optometrist in Bessemer, AL
• Providers in Bessemer, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2010; 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.