Healthcare Provider Details

I. General information

NPI: 1518093160
Provider Name (Legal Business Name): SO YEON TSE O.D., FAAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S. UNIVERSITY DRIVE
FT. LAUDERDALE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4200
  • Fax:
Mailing address:
  • Phone: 954-262-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6693
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPFC68
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: