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General NPI Number Information
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NPI Number | 1841593837
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Entity Type | Organization
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Legal Business Name | ANTHONY VINCENT POTTS OD PC
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 1575 W BIG BEAVER RD C11
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City | TROY
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State | MI
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Zip | 48084-3536
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Country | US
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Telephone | 248-649-2320
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Fax | 248-649-3444
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Provider Business Mailing Address
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Address Line | 1575 W BIG BEAVER RD C11
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City | TROY
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State | MI
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Zip | 48084-3536
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Country | US
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Telephone | 248-649-2320
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Fax | 248-649-3444
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | ANTHONY VINCET POTTS
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Credential | OD
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Telephone | 248-649-2320
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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 | 4901002335
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License Number State | IA
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