Healthcare Provider Details

I. General information

NPI: 1629058110
Provider Name (Legal Business Name): ANTHONY VINCENT POTTS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AV
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

1575 W BIG BEAVER RD
TROY MI
48084-3525
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0506
  • Fax:
Mailing address:
  • Phone: 301-295-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901002335
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: