MEDICARE: DR. LARRY CHARLES WALLIS 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	270A00350300	NJ
2	152W00000X	Optometrist	27T000023300	NJ

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	:	1821083585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY CHARLES WALLIS OD

Provider Business Mailing Address
First Line	:	PO BOX 93
Second Line	:	14 N BROADWAY
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-0093
Country	:	US
Telephone Number	:	856-456-3925
Fax Number	:	856-456-4748

Provider Business Practice Location Address
First Line	:	14 N BROADWAY
Second Line	:
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-1507
Country	:	US
Telephone Number	:	856-456-3925
Fax Number	:	856-456-4748

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	10/30/2007

Similar Medicare Providers

1316382740 — DR. LARRY CHARLES WALLIS LLC
Practice Location Address:

14 N BROADWAY , POB93
GLOUCESTER CITY, NJ
08030-1507

Practice Phone: 856-456-3925
Practice Fax:

1851233530 — TAKEESHA DANIELLE THOMAS
Practice Location Address:

705 POWELL ST
GLOUCESTER CITY, NJ
08030-2045

Practice Phone: 609-922-8861
Practice Fax:

1265411458 — CITY OF GLOUCESTER CITY
Practice Location Address:

1 N KING ST
GLOUCESTER CITY, NJ
08030-1726

Practice Phone: 856-456-0231
Practice Fax: 856-456-0882

1467403196 — ISIAKA A BOLARINWA M.D
Practice Location Address:

822 KLEMM AVE
GLOUCESTER CITY, NJ
08030-1627

Practice Phone: 856-282-5566
Practice Fax: 856-396-9917

1811001514 — MARSHALL PRESSMAN D.O.
Practice Location Address:

420 MONMOUTH ST
GLOUCESTER CITY, NJ
08030-1722

Practice Phone: 856-456-5997
Practice Fax: 856-456-5713

1346335023 — DANIEL J HYMAN DO
Practice Location Address:

14 S BROADWAY
GLOUCESTER CITY, NJ
08030-1706

Practice Phone: 856-456-0518
Practice Fax: 856-456-4359

Directions to “ DR. LARRY CHARLES WALLIS OD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.