Dr. James N. Tisdale, O.D., P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

02309TG Issued in TX

Legal business name

DR. JAMES N. TISDALE, O.D., P.C.

Practice address

114 Professional Park Dr
Victoria, TX 77904-2351

Phone

(361) 578-8441

Fax

(361) 578-8494

NPI assigned

Mar 19, 2008

Last updated

May 13, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James N. Tisdale, OPTOMETRISTNPI 1073622692

Title

President Corporation

Phone

(361) 578-8441

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James N. Tisdale, O.D.

  • Optometrist
  • Victoria, TX
  • NPI 1073622692
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1407027212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 PROFESSIONAL PARK DR",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042351",
            "telephone_number": "361-578-8441",
            "fax_number": "361-578-8494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 PROFESSIONAL PARK DR",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042351",
            "telephone_number": "361-578-8441",
            "fax_number": "361-578-8494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JAMES N. TISDALE, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "TISDALE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT CORPORATION",
        "authorized_official_telephone_number": "361-578-8441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OPTOMETRIST"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "02309TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "0064QT",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE RAILROAD RETIREMENT BOARD'S MEDICARE CARRIER",
            "identifier": "DN6427",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "440-56-97",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Victoria, TX
• Providers in Victoria, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.