Craig Brian Tisch, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

005672 Issued in NY

Practice address

244 West 54TH Street
Suite 402
New York, NY 10019

Phone

(212) 765-2660

Fax

(212) 765-2714

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Miles and Tisch Eyecare Associates LTDGroup PAC ID 2668361635, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Miles & Tisch Eyecare Associates LTD

  • Optometrist
  • New York, NY
  • NPI 1033390844
  Medicare reassignment Care Compare group NPD Authorized official
• Pen Optical and Associates Inc.

  • Optometrist
  • New York, NY
  • NPI 1699957944
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1346316718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 WEST 54TH STREET",
            "address_2": "SUITE 402",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10019",
            "telephone_number": "212-765-2660",
            "fax_number": "212-765-2714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 WEST 54TH STREET",
            "address_2": "SUITE 402",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10019",
            "telephone_number": "212-765-2660",
            "fax_number": "212-765-2714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISCH",
        "first_name": "CRAIG",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV005672-1",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "005672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01618693",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "C03651",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01777128",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Jillian Tirsun, DDS
• Seth Richard Tirsun, DDS
• Claudette Ocampo Tiru, MD
• Siddharth Tirumala, MD
• Tisane Pharmacy LLC
• Bryan Ross Tischenkel, M.D.
• Suheily Tise
• Hannah Brooke Tishman, LMSW
• Julia G Tishman, RD
• Lynn P Tishman, LCSW, PH.D.

• Optometrist in New York, NY
• Providers in New York, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.