Individual
DR. JAMES N. TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
114 PROFESSIONAL PARK DR, VICTORIA, TX 77904-2351
(361) 578-8441
Mailing address
114 PROFESSIONAL PARK DR, VICTORIA, TX 77904-2351
(361) 578-8441
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2309TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410011742
THE RAILROAD RETIREMENT BOARD'S MEDICARE CARRIER
TX
01
—
440-56-97
AETNA
TX
01
—
82179Q
BC/BS
TX
Enumeration date
08/29/2006
Last updated
12/04/2013
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