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General NPI Number Information
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NPI Number | 1003088626
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Entity Type | Organization
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Legal Business Name | POTTER OPTOMETRY, INC.
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 8254 MAYBERRY SQ N
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City | SYLVANIA
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State | OH
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Zip | 43560-9457
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Country | US
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Telephone | 419-885-5300
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Fax | 419-885-5308
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Provider Business Mailing Address
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Address Line | 8006 N BRIDGE WAY
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City | MAUMEE
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State | OH
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Zip | 43537-9495
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Country | US
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Telephone | 419-885-5300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROXANNA T POTTER
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Credential | O.D.
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Telephone | 419-705-5143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5738/T2652
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License Number State | OH
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