Healthcare Provider Details

I. General information

NPI: 1326988494
Provider Name (Legal Business Name): DARRAH SUSAN POTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CLEARLAKE RD
COCOA FL
32922-5716
US

IV. Provider business mailing address

6085 CHAPMAN ST
COCOA FL
32927-8807
US

V. Phone/Fax

Practice location:
  • Phone: 321-631-0373
  • Fax: 321-631-0375
Mailing address:
  • Phone: 321-631-0373
  • Fax: 321-631-0375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO6596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: