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General NPI Number Information
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NPI Number | 1427260256
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Entity Type | Organization
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Legal Business Name | PAUL C. TISDAL, O.D., P.C.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1545 N. WASHINGTON AVE
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City | WEATHERFORD
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State | OK
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Zip | 73096
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Country | US
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Telephone | 158-072-2819
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Fax | 158-077-2280
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Provider Business Mailing Address
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Address Line | P.O. BOX 308
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City | WEATHERFORD
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State | OK
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Zip | 73096
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Country | US
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Telephone | 580-772-2819
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Fax | 580-772-2805
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL CARROLL TISDAL
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Credential | O.D.
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Telephone | 580-772-2819
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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 | 1016
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License Number State | OK
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