Provider Demographics
NPI:1790136760
Name:AMBROSE, SOPHIE ROBINSON (OD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIE
Middle Name:ROBINSON
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:20301 N HAYDEN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3865
Mailing Address - Country:US
Mailing Address - Phone:480-991-0509
Mailing Address - Fax:
Practice Address - Street 1:20301 N HAYDEN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3865
Practice Address - Country:US
Practice Address - Phone:480-991-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist