NPIMap

Organization Active NPI

Potter Optometry, Inc.

  • Optometrist
  • Sylvania, OH
National Provider Identifier
1003088626
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5738/T2652 Issued in OH
Legal business name
POTTER OPTOMETRY, INC.
Practice address
8254 Mayberry SQ N
Sylvania, OH 43560-9457
Phone
(419) 885-5300
Fax
(419) 885-5308
NPI assigned
Mar 25, 2008
Last updated
Dec 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Roxanna T Potter, O.D.NPI 1790797579
Title
President
Phone
(419) 705-5143

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 5738/T2652 OH Primary

Addresses

Primary practice location

8254 Mayberry SQ N
Sylvania, OH 43560-9457

Mailing address

8006 N Bridge Way
Maumee, OH 43537-9495
Phone (419) 885-5300

Other identifiers 1

IdentifierTypeStateIssuer
2831467MedicaidOH

Other names 1

  • Personal Eyecare Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1003088626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8006 N BRIDGE WAY",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435379495",
            "telephone_number": "419-885-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8254 MAYBERRY SQ N",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435609457",
            "telephone_number": "419-885-5300",
            "fax_number": "419-885-5308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTTER OPTOMETRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "ROXANNA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-705-5143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5738/T2652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2831467",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Personal Eyecare",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Sylvania, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.