Provider Demographics
NPI:1902070055
Name:AMY L. MOTT OD PA
Entity Type:Organization
Organization Name:AMY L. MOTT OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-433-1121
Mailing Address - Street 1:13300 S CLEVELAND AVE STE 45
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3883
Mailing Address - Country:US
Mailing Address - Phone:239-433-1121
Mailing Address - Fax:
Practice Address - Street 1:13300 S CLEVELAND AVE STE 45
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3883
Practice Address - Country:US
Practice Address - Phone:239-433-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8665OtherGROUP#
FL20439UMedicare UPIN