Active NPI
Scott Tashiro Tisdale, O.D.
- Optometrist
- Woodbury, NY
National Provider Identifier
1255594453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TUV007268
- Practice address
- 8565 Jericho Tpke
Woodbury, NY 11797-1804 - Phone
- (516) 367-3400
- NPI assigned
- Jul 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV007268 | NY | Primary |
Addresses
Primary practice location
8565 Jericho Tpke
Woodbury, NY 11797-1804
Mailing address
155E 38TH St 6L
New York, NY 10016-2675
Phone (516) 457-0757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080821000582 | NY | Practitioner - Optometry | 1951476183 | Practice locations: Woodbury, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007268 | NY | MD | Clinical Psychologist |
| TUV007268 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fort Tryon Optical Inc. | Optometrist | Past | Accepting new patients |
| Mda Management Inc | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Optometrist
- New York, NY
- NPI 1215238282
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460073600000",
"number": "1255594453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155E 38TH ST 6L",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100162675",
"telephone_number": "516-457-0757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8565 JERICHO TPKE",
"city": "WOODBURY",
"state": "NY",
"postal_code": "117971804",
"telephone_number": "516-367-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TISDALE",
"first_name": "SCOTT",
"middle_name": "TASHIRO",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-08",
"last_updated": "2016-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV007268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, NY
- The Stop & Shop Supermarket Company, LLC (Stop and Shop Pharmacy 511)
- Theradynamics Rehab MGMT., LLC
- Joel S Thomas
- Mary Emily Thrall, M.S.W.
- Scott Tillman, DDS
- Cindy Tobin, M.D.
- Patricia L Topper, OPTICIAN
- Town Total Compounding Centers, LLC
- Town Total Health, LLC (Meijer Pharmacy #459)
- True North Dialysis Center LLC (Crossways Park Dialysis)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.