Provider Demographics
NPI:1033390844
Name:MILES & TISCH EYECARE ASSOCIATES LTD
Entity type:Organization
Organization Name:MILES & TISCH EYECARE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:TISCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-765-2660
Mailing Address - Street 1:244 WEST 54TH STREET
Mailing Address - Street 2:SUITE, 402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5704
Mailing Address - Country:US
Mailing Address - Phone:212-765-2660
Mailing Address - Fax:212-765-2714
Practice Address - Street 1:244 WEST 54TH STREET
Practice Address - Street 2:SUITE, 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5704
Practice Address - Country:US
Practice Address - Phone:212-765-2660
Practice Address - Fax:212-765-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005672-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01777128Medicaid
NY01777128Medicaid
NY0361830001Medicare NSC