Provider Demographics
NPI:1235588187
Name:CUOMO, AMY LEE (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEE
Last Name:CUOMO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LEE
Other - Last Name:RAYLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:19 DUNSTER ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5002
Mailing Address - Country:US
Mailing Address - Phone:617-354-5590
Mailing Address - Fax:
Practice Address - Street 1:19 DUNSTER ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5002
Practice Address - Country:US
Practice Address - Phone:617-354-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist