Provider Demographics
NPI:1033745773
Name:ASHLEY OTT OD LLC
Entity Type:Organization
Organization Name:ASHLEY OTT OD LLC
Other - Org Name:ROBERTSDALE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:251-973-6040
Mailing Address - Street 1:21530 PROFESSIONAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-9911
Mailing Address - Country:US
Mailing Address - Phone:251-973-6040
Mailing Address - Fax:251-973-3140
Practice Address - Street 1:21530 PROFESSIONAL DR STE D
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-9911
Practice Address - Country:US
Practice Address - Phone:251-975-7507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty