Provider Demographics
NPI:1518904655
Name:LISLE FAMILY EYE CARE INC
Entity type:Organization
Organization Name:LISLE FAMILY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LISLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-346-8500
Mailing Address - Street 1:747 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1044
Mailing Address - Country:US
Mailing Address - Phone:812-346-8500
Mailing Address - Fax:812-352-8308
Practice Address - Street 1:747 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1044
Practice Address - Country:US
Practice Address - Phone:812-346-8500
Practice Address - Fax:812-352-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000205593OtherMARGARET LISLE ANTHEM #
IN200345210Medicaid
IN200347550Medicaid
IN000000205594OtherJAMES LISLE ANTHEM #
INU85566Medicare UPIN
IN000000205593OtherMARGARET LISLE ANTHEM #
INU85567Medicare UPIN
IN200345210Medicaid
IN182120BMedicare ID - Type UnspecifiedMARGARET LISLE MEDICARE #