Provider Demographics
NPI:1932265519
Name:SPOTTS, AMY L R (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L R
Last Name:SPOTTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:RUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:912 ACRI RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2248
Mailing Address - Country:US
Mailing Address - Phone:717-732-7035
Mailing Address - Fax:717-732-7035
Practice Address - Street 1:3015 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3042
Practice Address - Country:US
Practice Address - Phone:717-600-2020
Practice Address - Fax:717-600-2001
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-002322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001728579 0001Medicaid
PA685796Medicare PIN
PA001728579 0001Medicaid
PA685796NOYMedicare PIN