Organization
BE THOU MY VISION, PC
Active
Other names
Be Thou My Vision
Organization subpart
No
Provider details
NPI number
Authorized official
BLAKE CARLISLE OD (PRESIDENT)
(580) 227-4878
Entity
Organization
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
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
973
OK
332H00000X
Eyewear Supplier
973
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0246290001
DME MAC C
OK
05
—
100766110B
—
OK
01
—
DG6895
RAILROAD MEDICARE
OK
Enumeration date
01/24/2007
Last updated
10/29/2020
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