Healthcare Provider Details

I. General information

NPI: 1730141730
Provider Name (Legal Business Name): AMY Y TSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 WATERBURY RD. SUITE 201
PROSPECT CT
06712
US

IV. Provider business mailing address

166 WATERBURY RD. SUITE 201
PROSPECT CT
06712
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-5733
  • Fax: 203-758-7400
Mailing address:
  • Phone: 203-758-5733
  • Fax: 203-758-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number029012
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: