Whitney Morgan Wallace, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046011612 Issued in IL

Practice address

724 E Boughton Rd
Bolingbrook, IL 60440-2279

Phone

(630) 633-5631

NPI assigned

Jun 2, 2022

Sex

Female

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": "1654128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1902545320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 SPINNING WHEEL RD APT 6B",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605217639",
            "telephone_number": "207-730-9391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 E BOUGHTON RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402279",
            "telephone_number": "630-633-5631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WHITNEY",
        "middle_name": "MORGAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-02",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE NUMBER",
            "identifier": "046011612",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.