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General NPI Number Information
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NPI Number | 1407027212
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Entity Type | Organization
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Legal Business Name | DR. JAMES N. TISDALE, O.D., P.C.
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 114 PROFESSIONAL PARK DR
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City | VICTORIA
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State | TX
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Zip | 77904-2351
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Country | US
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Telephone | 361-578-8441
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Fax | 361-578-8494
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Provider Business Mailing Address
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Address Line | 114 PROFESSIONAL PARK DR
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City | VICTORIA
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State | TX
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Zip | 77904-2351
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Country | US
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Telephone | 361-578-8441
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Fax | 361-578-8494
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Authorized Official
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Title or Position | PRESIDENT CORPORATION
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Name | DR. JAMES N. TISDALE
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Credential | OPTOMETRIST
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Telephone | 361-578-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02309TG
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License Number State | TX
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