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NPI Code Detail

MEDICARE: DR. BARBARA E. OTT O.D.

MEDICARE: DR. BARBARA E. OTT O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist046-008863IL

General Provider Information

NPI Number : 1851342588
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BARBARA E. OTT O.D.
Provider Business Mailing Address
First Line : 8309 N KNOXVILLE AVE
Second Line :
City : PEORIA
State : IL
Zip : 61615-2170
Country : US
Telephone Number : 309-693-9540
Fax Number : 309-693-9754
Provider Business Practice Location Address
First Line : 8309 N KNOXVILLE AVE
Second Line :
City : PEORIA
State : IL
Zip : 61615-2170
Country : US
Telephone Number : 309-713-3664
Fax Number : 309-839-0078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2006
Last Update Date : 01/04/2014

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