| Doctor Name: | DR. MICHAEL WALLACE |
| NPI Number: | 1689615346 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | O.D. |
| License Number: | 4901003070 |
| Business Practice Address: | 1379 Flushing Rd Flushing, MI - 484332262 |
| Business Phone Number: | 8106593135 |
| Business Fax Number: | 8106590024 |
| Mailing Address: | 1379 Flushing Rd, FLUSHING |
| State: | MI |
| Postal Code: | 484332262 |
| Phone Number: | 8106593135 |
| Fax Number: | 8106590024 |
| NPI Enumeration Date: | 06/10/2006 |
| NPI Last Update Date: | 05/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152W00000X |
| License Number: | 4901003070 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |