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Individual

DR. CHAD EVERETT TISDALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1729 NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5345
(910) 763-3601
(910) 763-4608
Mailing address
1729 NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5345
(910) 763-3601
(910) 763-4608

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2178
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5913156
NC
Enumeration date
10/27/2009
Last updated
10/27/2020
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