Healthcare Provider Details

I. General information

NPI: 1740815505
Provider Name (Legal Business Name): JOANNA VROTSOS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 MITYLENE PARK DR
MONTGOMERY AL
36117-3548
US

IV. Provider business mailing address

2800 ROSS CLARK CIR
DOTHAN AL
36301-2040
US

V. Phone/Fax

Practice location:
  • Phone: 334-260-8511
  • Fax: 334-260-8755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34505TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3529
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR-324-TA-C66
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: