Active NPI
Patricia Cisarik, O.D.
- Optometrist
- Memphis, TN
National Provider Identifier
1508869009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OFC27
- Practice address
- 1225 Madison Ave
Memphis, TN 38104-2211 - Phone
- (901) 722-3250
- Fax
- (901) 722-3347
- NPI assigned
- May 27, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
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
- Memphis, TN
- NPI 1851384986
-
- Optometrist
- Houston, TX
- NPI 1619250388
-
- Optometrist
- Houston, TX
- NPI 1205911963
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern College of Optometry
Practice addresses (Care Compare)
1245 Madison Ave
Memphis, TN 38104-2211
Phone (901) 722-3385
1245 Madison Ave
Memphis, TN 38104-2222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20090512000666 | TN | Practitioner - Optometry | 0941218622 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OFC27 | FL | MD | Optometrist |
| 5667T | TX | MD | Optometrist |
| 0601001408 | VA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern College of Optometry | Optometrist | Current | Accepting new patients |
| Marcus G. Piccolo, OD, PLLC | Optometrist | Past | Accepting new patients |
| Christine a Tyler OD PA | Optometrist | Past | Accepting new patients |
Locations
1245 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250
1225 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250
1350 Concourse Ave
Ste 264
Memphis, TN 38104
Phone (901) 252-3670
Specialties & licenses 4
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5667T | TX | |
| Optometrist | 152W00000X | OFC27 | FL | Primary |
| Optometrist | 152W00000X | 0601001408 | VA | |
| Optometrist | 152W00000X | 2850 | TN |
Addresses
NPPES NPI RegistryPrimary practice location
1225 Madison Ave
Memphis, TN 38104-2211
Mailing address
1245 Madison Ave
Memphis, TN 38104-2211
Phone (901) 722-3250
Other identifiers 2
NPPES NPI Registry| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2850 | Other | TN | OD |
| 1512996 | Medicaid | TN |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 7, 2023.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1508869009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1245 MADISON AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381042211",
"telephone_number": "901-722-3250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 MADISON AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381042211",
"telephone_number": "901-722-3250",
"fax_number": "901-722-3347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CISARIK",
"first_name": "PATRICIA",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-05-27",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "5667T",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OFC27",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0601001408",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TN",
"license": "2850",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OD",
"identifier": "2850",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1512996",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.