Provider Demographics
NPI:1932648037
Name:JAY LOTT OD
Entity Type:Organization
Organization Name:JAY LOTT OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:954-937-6101
Mailing Address - Street 1:27370 KIM DR
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-7470
Mailing Address - Country:US
Mailing Address - Phone:954-937-6101
Mailing Address - Fax:
Practice Address - Street 1:7950 HIGHWAY 72 W
Practice Address - Street 2:SUITE E
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-6416
Practice Address - Country:US
Practice Address - Phone:256-830-1050
Practice Address - Fax:256-325-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C01-TA-834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I410311Medicare PIN