C WALLACE LILES JR OD PA (NPI# 1316165178) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316165178 |
| Entity Type | Organization |
| Organization Name | C WALLACE LILES JR OD PA |
| Other Organization Name | LILES VISION CLINIC |
| Practice Address |
404d E Collin Raye Dr De Queen AR 71832-4149 |
| Practice Telephone | 8706426900 |
| Practice Fax Number | 8706424928 |
| Mailing Telephone | 8706426900 |
| Mailing Fax Number | 8706424928 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2009-09-01 |
| Authorized Official Name | DR. C. WALLACE LILES VI (DR.) |
| Authorized Official Telephone | 8706426900 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | AR2331 | AR | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 113655722 | 05 |
| Other Name | Type Code |
|---|---|
| LILES VISION CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043438807 | C Wallace Liles Jr Od Pa | Optometrist | 72 W 2nd St, Waldron, AR 72958-7085 | 2007-04-24 |
| Street Address |
404D E COLLIN RAYE DR |
| City | DE QUEEN |
| State | AR |
| Zip Code | 71832-4149 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841756137 | Med Southwest, Pllc | Optometrist | 404d E Collin Raye Dr, De Queen, AR 71832-4149 | 2019-02-12 |
| 1376948687 | C Wallace Liles IIi O D LLC | Optometrist | 404d E Collin Raye Dr, De Queen, AR 71832-4149 | 2014-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487149985 | Healthcare Express, LLP | Clinic/Center | 1021 W. Collin Raye Dr., Dequeen, AR 71832 | 2018-06-27 |
| 1982963781 | Callie Montana Miller | Specialist/Technologist | 194 Choctaw Trail, Dequeen, AR 71832 | 2012-05-14 |
| 1023376589 | Dequeen Medical Center | Rehabilitation Hospital | 1306 W Collin Dr., Dequeen, AR 71832 | 2012-05-02 |
| 1083971428 | Renee Logan | Pharmacist | 205 W De Queen Ave., De Queen, AR 71832 | 2012-04-23 |
| 1538434295 | Angela Kay Martin | Nurse Practitioner | 1302 W. Collin Raye Dr., Suite A, Dequeen, AR 71832 | 2012-03-14 |
| 1386950624 | Charles Norman Alston IIi | Dentist | 110 W. De Queen Avenue, De Queen, AR 71832 | 2010-08-24 |
| 1609181783 | De Queen Medical Center Inc | Home Health | 1007 N 14th St, De Queen, AR 71832 | 2010-08-12 |
| 1821301466 | Claire Terece Russell | Nurse Practitioner | 500 E. Collin Raye Dr, Dequeen, AR 71832 | 2010-07-25 |
| 1043445455 | Smiles of Arkansas Dental Center, Pllc | Dentist | 110 West Dequeen Avenue, Suite B, Dequeen, AR 71832 | 2009-05-29 |
| 1538319496 | Kerri Allison Ross | Speech-Language Pathologist | 122 Crestwood Dr., Dequeen, AR 71832 | 2008-09-26 |
| Find all providers in zip 71832 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| 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. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841756137 | Med Southwest, Pllc | Optometrist | 404d E Collin Raye Dr, De Queen, AR 71832-4149 | 2019-02-12 |
| 1376948687 | C Wallace Liles IIi O D LLC | Optometrist | 404d E Collin Raye Dr, De Queen, AR 71832-4149 | 2014-10-29 |
| 1619308541 | Bowman Family Eye Care Pllc | Optometrist | 1302 W Collin Raye Dr, De Queen, AR 71832-2502 | 2013-12-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497373088 | Taylor Renz | Optometrist | 1225 W Beebe Capps Expy, Searcy, AR 72143-5179 | 2020-07-09 |
| 1932733185 | Ashley Mcgee | Optometrist | 723 Falls Blvd S Ste A, Wynne, AR 72396-3509 | 2020-02-26 |
| 1972144566 | Randy Bell Od Pllc | Optometrist | 101 W Walnut St, Rogers, AR 72756-6662 | 2019-10-04 |
| 1881241792 | Radiant Eye Care Optometric Corporation | Optometrist | 1210 Jtl Pkwy E Ste 103, Springdale, AR 72762-7019 | 2019-08-25 |
| 1457905903 | Heather Snyder | Optometrist | 1021 South Waldron Road, Fort Smith, AR 72903 | 2019-08-01 |
| 1568024230 | Lawrence Allen King IIi | Optometrist | 4300 Rogers Ave Ste 46, Fort Smith, AR 72903-3152 | 2019-07-02 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1417413717 | Med Southwest, Pllc | Optometrist | 114 E 49th St, Texarkana, AR 71854-2117 | 2019-02-12 |
| 1588120877 | Med Southwest, Pllc | Optometrist | 2510 N Hervey St, Hope, AR 71801-8419 | 2019-02-12 |
| 1093279275 | Piper's Vision Xpress, LLC | Optometrist | 50 Paul Wood Lane, Mountian Home, AR 72653 | 2019-01-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.