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General NPI Number Information
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NPI Number | 1578971396
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Entity Type | Individual
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Provider Name | RUSSELL ISAAC LILES O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 4415 LOOP 322
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City | ABILENE
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State | TX
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Zip | 79602-8056
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Country | US
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Telephone | 325-603-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 4415 LOOP 322
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City | ABILENE
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State | TX
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Zip | 79602-8056
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Country | US
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Telephone | 325-370-5513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2817
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8529TG
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8529T
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License Number State | TX
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