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General NPI Number Information
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NPI Number | 1508869009
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Entity Type | Individual
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Provider Name | PATRICIA CISARIK O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1225 MADISON AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-2211
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Country | US
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Telephone | 901-722-3250
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Fax | 901-722-3347
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Provider Business Mailing Address
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Address Line | 1245 MADISON AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-2211
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Country | US
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Telephone | 901-722-3250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5667T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OFC27
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601001408
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2850
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License Number State | TN
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