Active NPI
Ralph Robert Tisdale, OPHTHALMIC DISPENSER
- Contact Lens Fitter
- Seaford, NY
National Provider Identifier
1992903322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contact Lens Fitter
- License
- C003643-1
- Practice address
- 3844 Sunrise Hwy
Seaford, NY 11783-2634 - Phone
- (516) 781-4444
- Fax
- (516) 781-4060
- NPI assigned
- Jul 6, 2007
- 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 |
|---|---|---|---|---|
| Contact Lens Fitter | 156FC0801X | C003643-1 | NY | Primary |
Addresses
Primary practice location
3844 Sunrise Hwy
Seaford, NY 11783-2634
Mailing address
3844 Sunrise Hwy
Seaford, NY 11783-2634
Phone (516) 781-4444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C003643-1 | NY | MD | Contact Lens Fitter |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234915200000",
"number": "1992903322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3844 SUNRISE HWY",
"city": "SEAFORD",
"state": "NY",
"postal_code": "117832634",
"telephone_number": "516-781-4444",
"fax_number": "516-781-4060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3844 SUNRISE HWY",
"city": "SEAFORD",
"state": "NY",
"postal_code": "117832634",
"telephone_number": "516-781-4444",
"fax_number": "516-781-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TISDALE",
"first_name": "RALPH",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "OPHTHALMIC DISPENSER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-06",
"last_updated": "2009-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "156FC0801X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Contact Lens Fitter",
"state": "NY",
"license": "C003643-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seaford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.