Provider Demographics
NPI:1891368569
Name:AMBROSE, DAPHNE (OD)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:AMBROSE
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 1:1 GREYROCK PL APT 6100
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3151
Mailing Address - Country:US
Mailing Address - Phone:857-757-8137
Mailing Address - Fax:
Practice Address - Street 1:598 TUCKAHOE RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-5713
Practice Address - Country:US
Practice Address - Phone:914-586-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist