Individual
DR. SUSAN L CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2911
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
318005006
—
MO
01
—
4175
HEALTHCARE USA
MO
01
—
64485
DAVIS
—
01
—
92830
SPECTERA
MO
Enumeration date
08/09/2006
Last updated
12/17/2010
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