Healthcare Provider Details

I. General information

NPI: 1811332083
Provider Name (Legal Business Name): AMIRFARBOD YAZDANYAR MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 CROSS RD
WATERFORD CT
06385-1215
US

IV. Provider business mailing address

174 CROSS RD
WATERFORD CT
06385-1215
US

V. Phone/Fax

Practice location:
  • Phone: 860-444-1292
  • Fax: 860-444-1827
Mailing address:
  • Phone: 860-444-1292
  • Fax: 860-444-1827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number73152
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA144400
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number285397-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: