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General NPI Number Information
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NPI Number | 1518904655
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Entity Type | Organization
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Legal Business Name | LISLE FAMILY EYE CARE INC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 747 N STATE ST
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City | NORTH VERNON
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State | IN
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Zip | 47265-1044
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Country | US
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Telephone | 812-346-8500
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Fax | 812-352-8308
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Provider Business Mailing Address
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Address Line | 747 N STATE ST
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City | NORTH VERNON
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State | IN
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Zip | 47265-1044
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Country | US
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Telephone | 812-346-8500
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Fax | 812-352-8308
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES THOMAS LISLE
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Credential | O.D.
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Telephone | 812-346-8500
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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 |
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License Number State |
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