Provider Demographics
NPI:1568587137
Name:MOTT, AMY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:MOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:WRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1370 WHISKEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2241
Mailing Address - Country:US
Mailing Address - Phone:239-850-2348
Mailing Address - Fax:
Practice Address - Street 1:13300 S CLEVELAND AVE STE 45
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3883
Practice Address - Country:US
Practice Address - Phone:239-433-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20439UMedicare ID - Type Unspecified
FLU35113Medicare UPIN