Provider Demographics
NPI:1518184423
Name:COTTO, CARMEN IDALYS (OD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:IDALYS
Last Name:COTTO
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 1:2838 SARDIS MILL TRL
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6263
Mailing Address - Country:US
Mailing Address - Phone:770-365-9899
Mailing Address - Fax:
Practice Address - Street 1:2205 PLEASANT HILL RD
Practice Address - Street 2:SUITE 125
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2324
Practice Address - Country:US
Practice Address - Phone:770-497-8100
Practice Address - Fax:770-497-9301
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist