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Individual

JENNIFER MARGARET CARLISLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
2250 EASTERN BLVD, MONTGOMERY, AL 36117-1555
(334) 274-2020
(334) 396-9924
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPT003228
GA
152W00000X
Optometrist
Primary
S-E26-TA-B61
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
S-E26
TEMPORARY OPTOMETRIC LICENSE
AL
Enumeration date
07/18/2019
Last updated
10/15/2021
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