Provider Demographics
NPI:1083054217
Name:RAO, AMOOLYA (OD)
Entity Type:Individual
Prefix:
First Name:AMOOLYA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BELLTOWN RD APT 7
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3725
Mailing Address - Country:US
Mailing Address - Phone:630-788-0823
Mailing Address - Fax:
Practice Address - Street 1:COASTAL EYE
Practice Address - Street 2:600 W PUTNAM AVE, LOWER LEVEL
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-900-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist