Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 073612 | IA |
NPI | 1013320985 |
---|---|
Provider Name | Dr. Andrew Thomas Ott |
First Address | Pella, IA 50219-1636 |
Second Address | Pella, IA 50219-1636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2014 |
Last Update Date | 08/06/2014 |