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Individual

DR. SUSAN L CARLISLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
201 HIGHLANDS BOULEVARD DR, BALLWIN, MO 63011-4383
(636) 256-3285
Mailing address
201 HIGHLANDS BOULEVARD DR, BALLWIN, MO 63011-4383
(636) 256-3285

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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