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General NPI Number Information
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NPI Number | 1023427507
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Entity Type | Organization
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Legal Business Name | PALAK B WALL MD PLLC
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 120 N EAGLE CREEK DR
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City | LEXINGTON
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State | KY
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Zip | 40509-1827
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Country | US
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Telephone | 614-565-6088
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Fax |
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Provider Business Mailing Address
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Address Line | 2197 WESTMONT CT
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City | LEXINGTON
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State | KY
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Zip | 40513-1222
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Country | US
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Telephone | 614-565-6088
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | PALAK B WALL
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Credential |
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Telephone | 614-565-6088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 47245
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License Number State | KY
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