Provider Demographics
NPI:1730141730
Name:TSO, AMY Y (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:Y
Last Name:TSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 WATERBURY RD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712
Mailing Address - Country:US
Mailing Address - Phone:203-758-5733
Mailing Address - Fax:203-758-7400
Practice Address - Street 1:166 WATERBURY RD.
Practice Address - Street 2:SUITE 201
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712
Practice Address - Country:US
Practice Address - Phone:203-758-5733
Practice Address - Fax:203-758-7400
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029012207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001290121Medicaid
CT180000710Medicare ID - Type Unspecified
CT001290121Medicaid