Individual
DR. JAMES THOMAS LISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
747 N STATE ST, NORTH VERNON, IN 47265-1044
(812) 346-8500
(812) 352-8308
Mailing address
747 N STATE ST, NORTH VERNON, IN 47265-1044
(812) 352-6600
(812) 352-6600
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1415DT
KY
152W00000X
Optometrist
Primary
18002981A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200335310A
—
IN
05
—
200347550
—
IN
01
—
7700115400
KYHEALTH CHOICES
KY
01
—
924288
BLOCK VISION
KY
Enumeration date
08/30/2005
Last updated
12/06/2016
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