Individual
LARRY MICHAEL CHISM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
136 SHELLEY DR, TYLER, TX 75701-8723
(903) 561-8686
(906) 581-1518
Mailing address
136 SHELLEY DR, TYLER, TX 75701-8723
(903) 561-8686
(906) 581-1518
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02774TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0390950001
PALMETTO GBA MEDICARE
TX
01
—
08379
SPECTERA
TX
01
—
48849
DAVIS VISION
TX
01
—
552688
NVA
TX
01
—
81381Q
BLUECROSSBLUESHIELD
TX
01
—
909986
BLOCK VISION
TX
Enumeration date
02/27/2007
Last updated
07/08/2007
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