Provider Demographics
NPI:1881183564
Name:WALLACE W. TOWLE, OD PA
Entity Type:Organization
Organization Name:WALLACE W. TOWLE, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DC
Authorized Official - Middle Name:
Authorized Official - Last Name:YEARBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-624-5492
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-0549
Mailing Address - Country:US
Mailing Address - Phone:501-624-5492
Mailing Address - Fax:501-623-2242
Practice Address - Street 1:1827 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6848
Practice Address - Country:US
Practice Address - Phone:501-624-5492
Practice Address - Fax:501-623-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2196332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies