Provider Demographics
NPI:1790946499
Name:OTTE, NATHAN PAUL (OD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:PAUL
Last Name:OTTE
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 1:8432 N COUNTY ROAD 400 E
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-9121
Mailing Address - Country:US
Mailing Address - Phone:812-271-1700
Mailing Address - Fax:812-271-1345
Practice Address - Street 1:314 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2330
Practice Address - Country:US
Practice Address - Phone:812-271-1700
Practice Address - Fax:812-271-1345
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003519A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ3519OtherEYEMED
IN201195980 AMedicaid
IN200911940Medicaid
IN201195980 AMedicaid
IN54450009Medicare PIN