Blake Carlisle (NPI# 1073921524, PAC ID# 9638390826) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OPTOMETRY.
| Nation Provider ID (NPI) | 1073921524 |
| PAC ID by PECOS | 9638390826 |
| Professional Enrollment ID | I20141103000978 |
| Full Name | Blake Carlisle |
| Organization Legal Name | MAX CARLISLE OD PC |
| Address |
111 E Broadway Fairview OK 73737-2124 |
| Phone Number | 5802274878 |
| Gender | M |
| Graduation Year | 2014 |
| Primary Specialty | OPTOMETRY |
| Group Practice PAC ID | 5496837957 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 370171 | CHEROKEE NATION W W HASTINGS INDIAN HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 111 E Broadway, Fairview, OK 73737-2124 | 5802274878 | MAX CARLISLE OD PC |
| 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 9184583100 | CHEROKEE NATION |
| 16944 W Cherokee, Gadugi Health Center, Tahlequah, OK 74464-2512 | 9184586218 | CHEROKEE NATION |
| Organization Legal Name | MAX CARLISLE OD PC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Max Carlisle | Optometry | Max Carlisle Od PC | 111 E Broadway, Fairview, OK 73737-2124 |
| Street Address |
111 E BROADWAY |
| City | FAIRVIEW |
| State | OK |
| Zip | 73737-2124 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Steven D Hortness | Chiropractic | 111 E Broadway, Little Falls, MN 56345-3038 | |
| Max Carlisle | Optometry | Max Carlisle Od PC | 111 E Broadway, Fairview, OK 73737-2124 |
| Eric Dean Schultz | Physical Therapy | 111 E Broadway, Suite 340, Columbia, MO 65203-4208 | |
| Bret S Derrick | Physical Therapy | Broadway Ergonomics LLC | 111 E Broadway, Suite 340, Columbia, MO 65203-4208 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Elizabeth A Kimball | Nurse Practitioner | Fairview Regional Medical Center Authority | 523 E State Rd, Fairview Regional Medical Center, Fairview, OK 73737-1453 |
| John Stephen Price | Family Medicine | Fairview Regional Medical Center Authority | 523 E State Rd, Fairview Regional Medical Center, Fairview, OK 73737-1453 |
| Jerry D Braziel | Physician Assistant | Fairview Regional Medical Center Authority | 523 E State Rd, Fairview Regional Medical Center, Fairview, OK 73737-1453 |
| Donald R Klinger | Family Practice | Fairview Regional Medical Center Authority | 523 E State Rd, Fairview Regional Medical Center, Fairview, OK 73737-1453 |
| Megan L Ewing | Nurse Practitioner | Fairview Regional Medical Center Authority | 523 E State Rd, Fairview Regional Medical Center, Fairview, OK 73737-1453 |
| John A Hensley | Family Practice | Fairview Regional Medical Center Authority | 523 E State Rd, Fairview Regional Medical Center, Fairview, OK 73737-1453 |
| Justin Keen | Chiropractic | 301 W Elm St, Fairview, OK 73737-1618 | |
| John B Eitzen | Chiropractic | 123 W Broadway, Advanced Chiropratic Center, Fairview, OK 73737-2009 |
| City | FAIRVIEW |
| Zip Code | 73737 |
| Specialty | OPTOMETRY |
| City + Specialty | FAIRVIEW + OPTOMETRY |
Please comment or provide details below to improve the information on Blake Carlisle.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.