Provider Demographics
NPI:1124475793
Name:FRANCISCO, CHALISE LYNNE (OD)
Entity type:Individual
Prefix:
First Name:CHALISE
Middle Name:LYNNE
Last Name:FRANCISCO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHALISE
Other - Middle Name:LYNNE
Other - Last Name:MAYBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1000 VANN DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6062
Practice Address - Country:US
Practice Address - Phone:731-668-3018
Practice Address - Fax:731-660-6811
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist