NPI Code Detail JSON Logo

1952449837 NPI number — PHILIP L. POTTS O.D.

NPI Number: 1952449837
Health Care Provider/Practitioner: PHILIP L. POTTS O.D.

Information about “1952449837” NPI (PHILIP L. POTTS O.D.) exists in 1952449837 in HTML format HTML  |  1952449837 in plain Text format TXT  |  1952449837 in PDF (Portable Document Format) PDF  |  1952449837 in an XML format XML  formats.

NPI Number : 1952449837 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952449837",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POTTS",
    "FirstName": "PHILIP",
    "MiddleName": "L.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MATTSON",
    "OtherFirstName": "PHILIP",
    "OtherMiddleName": "L",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "OD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "7900 BAILEY COVE RD SE",
    "SecondLineMailingAddress": "SUITE C",
    "MailingAddressCityName": "HUNTSVILLE",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "35802-3324",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "256-882-1024",
    "MailingAddressFaxNumber": "256-882-1025",
    "FirstLinePracticeLocationAddress": "7900 BAILEY COVE RD SE",
    "SecondLinePracticeLocationAddress": "SUITE C",
    "PracticeLocationAddressCityName": "HUNTSVILLE",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "35802-3324",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "256-882-1024",
    "PracticeLocationAddressFaxNumber": "256-882-1025",
    "EnumerationDate": "02/02/2007",
    "LastUpdateDate": "03/22/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "21400-875",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WV0400X",
          "TaxonomyName": "Vision Therapy Optometrist",
          "LicenseNumber": "S-A71-TA-632",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "S-A71-TA-632",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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