Provider Demographics
NPI:1679199822
Name:CRISI, TIFFANIE (OD)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:CRISI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TIE
Other - Middle Name:
Other - Last Name:CRISI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1119
Mailing Address - Country:US
Mailing Address - Phone:305-243-2020
Mailing Address - Fax:305-482-5141
Practice Address - Street 1:900 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1119
Practice Address - Country:US
Practice Address - Phone:305-243-2020
Practice Address - Fax:305-482-5141
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3321152W00000X
NY009913152W00000X
FLOPC5848152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist