Wallace, Robert Brian

Wallace, Robert Brian is an individual health care provider with primary practice located at 2014 S Irby St , Florence SC 29505-3420. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wallace, Robert Brian can be contacted via phone (843) 679-9005.

Contact Information

Primary practice address
2014 S Irby St Florence SC 29505-3420
Phone: (843) 679-9005
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X SC1088 South Carolina

Profile Details

NPI number 1609819952
LBN Legal business name Wallace, Robert Brian
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 14th, 2006
Last updated Jul 8th, 2007 - about 19 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 1609819952 NPPES
South Carolina MEDICAID D10888

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