National Provider Identifier
Larry B Wallace, OD
Larry B Wallace, OD is listed in the NPPES registry with a primary specialty of Vision Therapy Optometrist in Ithaca, NY and a listed phone number of (607) 277-4749.
Profile Overview
- NPI
- 1073545059
- Provider Type
- Individual
- Primary Specialty
- Vision Therapy Optometrist
- Enumeration Date
- July 07, 2006
- Last Updated
- October 06, 2010
Practice Location
- 322 N Aurora St
- Ithaca, NY 14850-4202
Phone: (607) 277-4749
Mailing Address
- 322 N. Aurora St.
- Ithaca, NY 14850
Specialties
- Vision Therapy Optometrist (152WV0400X)
- Low Vision Rehabilitation Optometrist (152WL0500X)
Full Record
- NPI
- 1073545059
- Entity Type
- Individual
- Last Name
- Wallace
- First Name
- Larry
- Middle Name
- B
- Credential
- OD
- Mailing Street Address
- 322 N. Aurora St.
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850
- Mailing Country
- US
- Mailing Phone
- (607) 277-4749
- Mailing Fax
- (607) 277-5216
- Practice Street Address
- 322 N Aurora St
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-4202
- Practice Country
- US
- Practice Phone
- (607) 277-4749
- Practice Fax
- (607) 277-5216
- Enumeration Date
- July 07, 2006
- Last Updated
- October 06, 2010
- Sex
- Male
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Vision Therapy Optometrist (152WV0400X), Low Vision Rehabilitation Optometrist (152WL0500X)
- Other Identifiers
- T003212-1 (NY, Ny State License)