Organization
LARRY M CHISM PC
Active
Other names
Vision Source of Tyler
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY M CHISM OD (OWNER/OPTOMETRIST)
(903) 561-8686
Entity
Organization
Contact information
Practice address
136 SHELLEY DRIVE, TYLER, TX 75701
(903) 561-8686
(903) 581-1518
Mailing address
136 SHELLEY DRIVE, TYLER, TX 75701
(903) 561-8686
(903) 581-1518
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02774TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006FG
BLUECROSSBLUESHIELD
TX
Enumeration date
02/28/2007
Last updated
05/17/2012
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