Provider Demographics
NPI:1477792398
Name:TSAI, MAI LY (OD)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:LY
Last Name:TSAI
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 1:5979 E GRANT RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2368
Mailing Address - Country:US
Mailing Address - Phone:520-535-2588
Mailing Address - Fax:520-829-3558
Practice Address - Street 1:5979 E GRANT RD STE 107
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2368
Practice Address - Country:US
Practice Address - Phone:520-989-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13206T152W00000X
IN18003150A152W00000X
IL046009426152W00000X
AZ1719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAPPLIED FORMedicaid
AZAPPLIED FORMedicaid