Wallace, Fred

Wallace, Fred is an individual health care provider with primary practice located at 1431 2Nd Ave N , Bessemer AL 35020-5608. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wallace, Fred can be contacted via phone (205) 425-5182.

Contact Information

Primary practice address
1431 2Nd Ave N Bessemer AL 35020-5608
Phone: (205) 425-5182
Fax: (205) 426-5013
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X S-517-TA-090 Alabama

Profile Details

NPI number 1497850085
LBN Legal business name Wallace, Fred
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2006
Last updated Jun 2nd, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497850085 NPPES
Alabama Other 051059719 BLUE CROSS
Alabama MEDICAID 000059719 BLUE CROSS
Alabama Other P00077951 BLUE CROSS

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