Provider Demographics
NPI:1336136886
Name:LOTTON, BART A (OD)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:A
Last Name:LOTTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4043
Mailing Address - Country:US
Mailing Address - Phone:406-254-6514
Mailing Address - Fax:
Practice Address - Street 1:1649 MAIN ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4043
Practice Address - Country:US
Practice Address - Phone:406-254-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0336581Medicaid
MAW17425Medicare ID - Type Unspecified
MAU90080Medicare UPIN