MEDICARE: DR. CROSBY W WALLACE O.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	152W00000X	Optometrist	5527TG	TX

General Provider Information

NPI Number	:	1255460705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CROSBY W WALLACE O.D.

Provider Business Mailing Address
First Line	:	6640 CYPRESSWOOD DR
Second Line	:	STE 105
City	:	SPRING
State	:	TX
Zip	:	77379-7738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6640 CYPRESSWOOD DR
Second Line	:	STE 105
City	:	SPRING
State	:	TX
Zip	:	77379-7738
Country	:	US
Telephone Number	:	281-355-9090
Fax Number	:	281-602-8419

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	12/06/2024

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Directions to “ DR. CROSBY W WALLACE O.D.” Practice Location

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