Individual
MR. MAX L CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
111 E BROADWAY, FAIRVIEW, OK 73737-2124
(580) 227-4878
(580) 227-4666
Mailing address
111 E BROADWAY, FAIRVIEW, OK 73737-2124
(580) 227-4878
(580) 227-4666
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
973
OK
152WC0802X
Corneal and Contact Management Optometrist
973
OK
152WL0500X
Low Vision Rehabilitation Optometrist
973
OK
152WP0200X
Pediatric Optometrist
973
OK
152WS0006X
Sports Vision Optometrist
973
OK
152WV0400X
Vision Therapy Optometrist
973
OK
152WX0102X
Occupational Vision Optometrist
973
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0246290001
PALMETTO DMERC
OK
05
—
100766110A
—
OK
01
—
410046324
RAILROAD MEDICARE
OK
Enumeration date
05/31/2005
Last updated
12/23/2013
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