Active NPI
Dennis Jaye Wallace, OD
- Optometrist
- Farmersville, CA
National Provider Identifier
1699741777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT5964 TPA
- Practice address
- 662 East Visalia Road
Farmersville, CA 93223 - Phone
- (559) 747-3461
- Fax
- (559) 594-4059
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT5964 TPA | CA | Primary |
| Optometrist | 152W00000X | 406OPT TPA | MT | |
| Optometrist | 152W00000X | OD00001112 | WA |
Addresses
Primary practice location
662 East Visalia Road
Farmersville, CA 93223
Mailing address
662 East Visalia Road
PO Box 475
Farmersville, CA 93223-0475
Phone (559) 747-3461
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2868614 | Other | CA | MEDICAL PASSWORD |
| SD0059640 | Other | BLUE SHIELD | |
| SD0059641 | Medicaid | CA |
Other names 1
- Dennis J Wallace
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5964 | CA | MD | Counselor |
| OPT5964 TPA | CA | MD | Optometrist |
| 406OPT TPA | MT | MD | Optometrist |
| OD00001112 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1699741777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "662 EAST VISALIA ROAD",
"address_2": "PO BOX 475",
"city": "FARMERSVILLE",
"state": "CA",
"postal_code": "932230475",
"telephone_number": "559-747-3461",
"fax_number": "559-594-4059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "662 EAST VISALIA ROAD",
"city": "FARMERSVILLE",
"state": "CA",
"postal_code": "93223",
"telephone_number": "559-747-3461",
"fax_number": "559-594-4059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DENNIS",
"middle_name": "JAYE",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT5964 TPA",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MT",
"license": "406OPT TPA",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "OD00001112",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL PASSWORD",
"identifier": "2868614",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "SD0059640",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0059641",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DENNIS",
"last_name": "WALLACE",
"middle_name": "J",
"credential": "OD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Farmersville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.