Organization
DR. JAMES N. TISDALE, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES N. TISDALE OPTOMETRIST (PRESIDENT CORPORATION)
(361) 578-8441
Entity
Organization
Contact information
Practice address
114 PROFESSIONAL PARK DR, VICTORIA, TX 77904-2351
(361) 578-8441
(361) 578-8494
Mailing address
114 PROFESSIONAL PARK DR, VICTORIA, TX 77904-2351
(361) 578-8441
(361) 578-8494
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02309TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064QT
BC/BS
TX
01
—
440-56-97
AETNA
TX
01
—
DN6427
THE RAILROAD RETIREMENT BOARD'S MEDICARE CARRIER
TX
Enumeration date
03/19/2008
Last updated
05/13/2014
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