Provider Demographics
NPI:1457859142
Name:RUSSELL LILES, O.D., PLLC
Entity Type:Organization
Organization Name:RUSSELL LILES, O.D., PLLC
Other - Org Name:ELITE EYECARE OF ABILENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:325-603-2020
Mailing Address - Street 1:4415 LOOP 322
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-8056
Mailing Address - Country:US
Mailing Address - Phone:325-603-2020
Mailing Address - Fax:325-690-0175
Practice Address - Street 1:4415 LOOP 322
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-8056
Practice Address - Country:US
Practice Address - Phone:325-603-2020
Practice Address - Fax:325-690-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8529T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty