Tim E Elcyzyn, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2569 Issued in AR

Practice address

3805 W 28TH Ave
Pine Bluff, AR 71603-4774

Phone

(870) 536-3100

Fax

(870) 536-3100

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cherokee Nation

  • Public Health or Welfare Agency
  • Tahlequah, OK
  • NPI 1013884154
  NPD (past)
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Tahlequah, OK
  • NPI 1093722324
  NPD (past)
• Northeastern State University College of Optometry

  • Optometrist
  • Tahlequah, OK
  • NPI 1437106333
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206662400000",
    "number": "1164433876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 W 28TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716034774",
            "telephone_number": "870-536-3100",
            "fax_number": "870-536-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 W 28TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716034774",
            "telephone_number": "870-536-3100",
            "fax_number": "870-536-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELCYZYN",
        "first_name": "TIM",
        "middle_name": "E",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2008-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "P00362854",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denise Edwards
• Jemeca Denise Edwards, M.D.
• Chinyere Joy Egbuna, MD
• Mary Egwuonwu, MD
• Kamaleldein Einar
• Koi Eley, LMSW
• Barbara Ellison, LPN
• Khi Ellison
• Joseph Elser, MD
• Abeer Elshaikh

• Optometrist in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.