IndividualActive
Gary Wallace, M.D.
NPI 1144335290 · Ophthalmology Physician · Idaho Falls, ID
Provider details
- NPI number
- 1144335290
- Entity type
- Individual
- Primary specialty
- Ophthalmology PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- License
- M-6226 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2295 Coronado Street
Idaho Falls, ID 83404
Phone: (208) 524-8600
Fax: (208) 524-8394
Approximate (ZIP-level) locationGet directions
Mailing address
2295 Coronado Street
Idaho Falls, ID 83404
Registry dates
- Enumerated
- 2006-08-20
- Last updated
- 2011-05-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.