Provider Demographics
NPI:1497975197
Name:BOTTI, ANTOINETTE L (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:L
Last Name:BOTTI
Suffix:
Gender:F
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:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501
Mailing Address - Country:US
Mailing Address - Phone:814-445-6395
Mailing Address - Fax:814-444-1292
Practice Address - Street 1:134 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501
Practice Address - Country:US
Practice Address - Phone:814-445-6395
Practice Address - Fax:814-444-1292
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
138233OtherEYEMED
6221TOtherVBA
VSP251621027OtherVSP
PA129484OtherMEDICAREB
410009029OtherPALMETTO GBA
AB129484OtherSPECTERA
251621027OtherPEBTF
392155OtherNVA
C000129484OtherUNITED AMERICAN INS CO
251621027OtherACORDIA
129484OtherMEDICAREB
53407OtherDAVIS
91053360936OtherAPWU
BO129484OtherCLARITY
0005422145OtherAETNA
399390OtherCOMBINED INS CO OF AMERIC
T29386Medicare UPIN
BO129484OtherCLARITY
251621027OtherPEBTF
PA1720256480Medicare UPIN