Provider Demographics
NPI:1568873263
Name:CARLISLE, TERESA (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5786
Mailing Address - Country:US
Mailing Address - Phone:256-624-6455
Mailing Address - Fax:
Practice Address - Street 1:822 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5786
Practice Address - Country:US
Practice Address - Phone:256-624-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALNOT REQUIRED156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician