Provider Demographics
NPI:1407130313
Name:CARLISLE VISION CLINIC PLLC
Entity Type:Organization
Organization Name:CARLISLE VISION CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-748-0693
Mailing Address - Street 1:712 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OK
Mailing Address - Zip Code:73932-3101
Mailing Address - Country:US
Mailing Address - Phone:580-625-2020
Mailing Address - Fax:580-625-2021
Practice Address - Street 1:712 AVENUE A
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932-3101
Practice Address - Country:US
Practice Address - Phone:580-625-2020
Practice Address - Fax:580-625-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty