Individual provider Active NPI

Alyssa Nicole Motter, OD

  • Optometrist
  • Vestal, NY
National Provider Identifier
1841180650
Registry record updated Jul 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
011186 Issued in NY
Practice address
3455 Vestal Pkwy E
Vestal, NY 13850-2134
Phone
(607) 722-2020
NPI assigned
Jul 4, 2025
Last updated
Jul 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 011186 NY Primary

Addresses

Primary practice location

3455 Vestal Pkwy E
Vestal, NY 13850-2134

Mailing address

111 E 4TH St Ste 440
Alton, IL 62002-6206

Other names 1

  • Miss Alyssa Nicole Widmer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250903003114 NY Practitioner - Optometry 7517469240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York Optometry Professional PLLCGroup PAC ID 5890169841, 26 clinicians

Practice addresses (Care Compare)

3455 Vestal Pkwy E
Vestal, NY 13850-2147
Phone (607) 722-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011186NYMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York Optometry Professional PLLC Optometrist CurrentSince Jul 13, 2025 Accepting new patients

Locations

111 E 4th St
Ste 440
Alton, IL 62002

75 Main St
Sidney, NY 13838
Phone (607) 563-2442

3455 Vestal Pkwy E
Vestal, NY 13850
Phone (607) 722-2020

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1751587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751587200000",
    "number": "1841180650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 VESTAL PKWY E",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138502134",
            "telephone_number": "607-722-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTTER",
        "first_name": "ALYSSA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-04",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "011186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "WIDMER",
            "middle_name": "NICOLE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Vestal, NY

Sources for this page

Verify at the official NPI Registry.