Carlisle Vision Clinic PLLC
Organization Active NPI Optometrist · Beaver, OK
NPI 1407130313 · NPPES record last updated Mar 9, 2012
Key facts
- NPI
- 1407130313
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2685 (OK)
- Legal business name
- CARLISLE VISION CLINIC PLLC
- Practice address
- 712 Avenue a
Beaver, OK 73932-3101 - Phone
- (580) 625-2020
- Fax
- (580) 625-2021
- NPI assigned
- Oct 11, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Trey Dean Carlisle, O.D.
- Title
- Owner
- Phone
- (580) 748-0693
Practitioners 2
-
Trey Dean Carlisle, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120110000080 | OK | Part B Supplier - Clinic/Group Practice | 5294901401 |
Receives reassigned benefits from 1 practitioner Practice locations: Beaver, OK; Laverne, OK |
National Provider Directory
Locations
712 Avenue A
Beaver, OK 73932
Phone (580) 625-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2685 | OK | Yes |
Addresses
Primary practice location
712 Avenue a
Beaver, OK 73932-3101
Mailing address
712 Avenue a
Beaver, OK 73932-3101
Phone (580) 625-2020
Other providers in Beaver, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.