MEDICARE: WALLACE W TOWLE OD

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	2196	AR

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	:	1710047857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALLACE W TOWLE OD

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:
City	:	HOT SPRINGS NATIONAL PARK
State	:	AR
Zip	:	71902-0549
Country	:	US
Telephone Number	:	501-624-5492
Fax Number	:	501-321-0001

Provider Business Practice Location Address
First Line	:	1827 CENTRAL AVE
Second Line	:
City	:	HOT SPRINGS NATIONAL PARK
State	:	AR
Zip	:	71901-6848
Country	:	US
Telephone Number	:	501-624-5492
Fax Number	:	501-321-0001

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	12/12/2017

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