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General NPI Number Information
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NPI Number | 1649486408
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Entity Type | Organization
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Legal Business Name | CHANDA W WALL OD PA
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 8432 LOCKWOOD RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34243-2903
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Country | US
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Telephone | 941-359-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 8432 LOCKWOOD RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34243-2903
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Country | US
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Telephone | 941-359-1105
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Fax | 941-359-1229
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. CHANDA WALL
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Credential | OD
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Telephone | 941-993-6188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 3435
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License Number State | FL
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