| Doctor Name: | LARRY B WALLACE |
| NPI Number: | 1073545059 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OD |
| License Number: | VUT003212 |
| Business Practice Address: | 322 N Aurora St Ithaca, NY - 148504202 |
| Business Phone Number: | 6072774749 |
| Business Fax Number: | 6072775216 |
| Mailing Address: | 322 N. Aurora St., ITHACA |
| State: | NY |
| Postal Code: | 14850 |
| Phone Number: | 6072774749 |
| Fax Number: | 6072775216 |
| NPI Enumeration Date: | 07/07/2006 |
| NPI Last Update Date: | 10/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WL0500X |
| License Number: | VUT003212 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Low Vision Rehabilitation |
| Taxonomy Definition: | Optometrists who specialize in low-vision care having training to assess visual function, prescribe low-vision devices, develop treatment plans, and recommend other vision rehabilitation services. |