Provider Demographics
NPI:1043471287
Name:SISLEY, JOSEPH NORMAN (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NORMAN
Last Name:SISLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8570 HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586
Mailing Address - Country:US
Mailing Address - Phone:812-547-3396
Mailing Address - Fax:812-547-5272
Practice Address - Street 1:8570 HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586
Practice Address - Country:US
Practice Address - Phone:812-547-3396
Practice Address - Fax:812-547-3396
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003513A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200904680Medicaid
P00804227Medicare PIN
IN256140BMedicare PIN
IN200904680Medicaid