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Contact Information

JASON WALLACE, OD
215 1ST ST N
STE.100
WINTER HAVEN, FL33881-4537
 Phone: 863-875-6568
 Fax: 863-299-1061
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for JASON WALLACE · (Male)

NPI Number 1689751166
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 11/01/2006
Last updated 11/17/2015 - About 6 months ago
Sole proprietor 1 No
Identifiers
FL License # OPC4182
Hospital affiliation(s) n/a
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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