Individual
DR. KARA LYNN TISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
301 E MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202
(502) 588-0550
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0330
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046.010570
IL
152W00000X
Optometrist
2120DT
KY
152W00000X
Optometrist
8442TG
TX
152WP0200X
Pediatric Optometrist
Primary
2120DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120DT
LICENSE
KY
05
—
300020905
—
IN
05
—
7100556990
—
KY
01
—
K116800
MEDICARE
KY
Enumeration date
07/13/2012
Last updated
12/28/2018
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