Provider Demographics
NPI:1952449837
Name:POTTS, PHILIP L (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:POTTS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:L
Other - Last Name:MATTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7900 BAILEY COVE RD SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3324
Mailing Address - Country:US
Mailing Address - Phone:256-882-1024
Mailing Address - Fax:256-882-1025
Practice Address - Street 1:7900 BAILEY COVE RD SE
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3324
Practice Address - Country:US
Practice Address - Phone:256-882-1024
Practice Address - Fax:256-882-1025
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21400-875152W00000X
ALS-A71-TA-632152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy