Evan Michael Criscio, OD
Individual provider Active NPI Optometrist · Edgewater, FL
NPI 1093294662 · NPPES record last updated Aug 17, 2018
Key facts
- NPI
- 1093294662
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPC5583 (FL)
- Practice address
- 2568 S Ridgewood Ave Ste 4
Edgewater, FL 32141 - Phone
- (386) 424-1422
- Fax
- (386) 424-1401
- NPI assigned
- Aug 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Blahnik Eye Care Inc
Practice addresses (Care Compare)
3740 S Ridgewood Ave
Unit 103
Port Orange, FL 32129-3519
Phone (386) 492-6999
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190131002603 | FL | Practitioner - Optometry | 6103163936 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blahnik Eye Care Inc | Optometrist | Current |
Accepting new patients |
| Volusia Center for Surgical Excellence, LLC | Past |
Accepting new patients |
Locations
3740 S Ridgewood Ave
Unit 103
Port Orange, FL 32129
Phone (386) 492-6999
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OPC5583 | FL | Yes |
Addresses
Primary practice location
2568 S Ridgewood Ave Ste 4
Edgewater, FL 32141
Mailing address
2568 S Ridgewood Ave Ste 4
Edgewater, FL 32141-7535
Phone (386) 424-1422
Other practice location 1
424 Luna Bella Ln Ste 127
New Smyrna Beach, FL 32168-4685
Phone (386) 957-3715
Other providers in Edgewater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.