Provider Demographics
NPI:1225183957
Name:BE THOU MY VISION, PC
Entity Type:Organization
Organization Name:BE THOU MY VISION, PC
Other - Org Name:BE THOU MY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-227-4878
Mailing Address - Street 1:111 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-2124
Mailing Address - Country:US
Mailing Address - Phone:580-227-4878
Mailing Address - Fax:580-227-4666
Practice Address - Street 1:111 E BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-2124
Practice Address - Country:US
Practice Address - Phone:580-227-4878
Practice Address - Fax:580-227-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
OK973332B00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0246290001OtherDME MAC C
OK100766110BMedicaid
OKDG6895OtherRAILROAD MEDICARE