Provider Demographics
NPI:1306156484
Name:SHOTTS, MELISSA GIBSON (OD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GIBSON
Last Name:SHOTTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-1807
Mailing Address - Country:US
Mailing Address - Phone:205-921-7426
Mailing Address - Fax:205-921-7589
Practice Address - Street 1:1925 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-6674
Practice Address - Country:US
Practice Address - Phone:205-921-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS823152W00000X
ALS-C36-TA-873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist