Dr Blake Carlisle, OD is a medicare enrolled "Optometrist" provider in Fairview, Oklahoma. He graduated from medical school in 2014 and has 11 years of diverse experience with area of expertise as Optometry. He is a member of the group practice Be Thou My Vision Pc and his current practice location is
111 E Broadway, Fairview, Oklahoma. You can reach out to his office (for appointments etc.) via phone at
(580) 227-4878.
Dr Blake Carlisle is licensed to practice in Oklahoma (license number 2804) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1073921524.
Healthcare Provider's Profile
| Full Name | Dr Blake Carlisle |
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| Gender | Male |
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| Speciality | Optometry |
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| Experience | 11 Years |
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| Location | 111 E Broadway, Fairview, Oklahoma |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Blake Carlisle graduated from medical school in 2014
NPI Data:
- NPI Number: 1073921524
- Provider Enumeration Date: 07/29/2014
- Last Update Date: 07/29/2014
Medicare PECOS Information:
- PECOS PAC ID: 9638390826
- Enrollment ID: I20141103000978
Medical Identifiers
Medical identifiers for Dr Blake Carlisle such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1073921524 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 152W00000X | Optometrist | 2804 (Oklahoma) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Be Thou My Vision Pc | 5496837957 | 3 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Blake Carlisle allows following entities to bill medicare on his behalf.
| Provider Name | Northeastern State University College Of Optometry |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1437106333
PECOS PAC ID: 0941112528
Enrollment ID: O20031103000296 |
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| Provider Name | Be Thou My Vision Pc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1225183957
PECOS PAC ID: 5496837957
Enrollment ID: O20080123000668 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Blake Carlisle is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Blake Carlisle, OD
111 E Broadway,
Fairview, OK 73737-2124
Ph: (580) 227-4878 | Dr Blake Carlisle, OD
111 E Broadway,
Fairview, OK 73737-2124
Ph: (580) 227-4878 |
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