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General NPI Number Information
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NPI Number | 1033745773
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Entity Type | Organization
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Legal Business Name | ASHLEY OTT OD LLC
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 21530 PROFESSIONAL DR STE D
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City | ROBERTSDALE
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State | AL
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Zip | 36567-9911
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Country | US
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Telephone | 251-975-7507
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Fax |
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Provider Business Mailing Address
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Address Line | 21530 PROFESSIONAL DR STE D
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City | ROBERTSDALE
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State | AL
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Zip | 36567-9911
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Country | US
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Telephone | 251-973-6040
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Fax | 251-973-3140
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASHLEY OTT
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Credential | OD
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Telephone | 251-973-6040
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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 |
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License Number State |
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