MEDICARE: DR. NANCY E WILLIAMS-WALLACE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	ME69004	FL
2	207W00000X	Ophthalmology Physician	ME69004	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184650970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY E WILLIAMS-WALLACE M.D.

Provider Business Mailing Address
First Line	:	2559 CENTENNIAL FALCON DR
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33596-6310
Country	:	US
Telephone Number	:	813-299-4931
Fax Number	:	727-772-6891

Provider Business Practice Location Address
First Line	:	36422 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1330
Country	:	US
Telephone Number	:	727-772-7712
Fax Number	:	727-772-6891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	12/07/2018

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Directions to “ DR. NANCY E WILLIAMS-WALLACE M.D.” Practice Location

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