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Contact Information

BLAKE CARLISLE, OD
111 E BROADWAY
FAIRVIEW, OK73737-2124
 Phone: 580-227-4878
 Fax: 580-227-4666
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for BLAKE CARLISLE · (Male)

NPI Number 1073921524
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 07/29/2014
Last updated 07/29/2014 - About 12 years ago
Sole proprietor 1 Yes
Identifiers
  • OK License # 2804
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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