Kirk D Wallis, R.D.O.

Primary specialty

OpticianTaxonomy code 156FX1800X

License

6273 Issued in CA

Practice address

44407 10TH St W
Lancaster, CA 93534-3345

Phone

(661) 942-6515

Fax

(661) 723-9293

NPI assigned

Feb 21, 2007

Last updated

Sep 18, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1649315920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44407 10TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935343345",
            "telephone_number": "661-942-6515",
            "fax_number": "661-723-9293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44407 10TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935343345",
            "telephone_number": "661-942-6515",
            "fax_number": "661-723-9293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "KIRK",
        "middle_name": "D",
        "credential": "R.D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "CA",
            "license": "6273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ35826Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roxanne Elizabeth Walker
• Tyler Walker
• Virginia Anne Walker, RD
• Janice Wallace
• Pamela Jene Wallace, BACHELORS, RADT
• Walmart Inc. (Walmart Pharmacy 10-2951)
• Walmart Inc. (Walmart Pharmacy 10-1563)
• Jessica Walsh, MD
• Joseph William Walsh, PH.D.
• Kelly Kristen Walter, BS

• Optician in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Optician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.