Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 946 | MS |
NPI | 1013360957 |
---|---|
Provider Name | Dr. Dillon Ott |
First Address | Wiggins, MS 39577-9605 |
Second Address | Wiggins, MS 39577-9605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2016 |
Last Update Date | 01/10/2020 |