Provider Demographics
NPI:1841180650
Name:MOTTER, ALYSSA NICOLE (OD)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:NICOLE
Last Name:MOTTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:NICOLE
Other - Last Name:WIDMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E 4TH ST STE 440
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3455 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2134
Practice Address - Country:US
Practice Address - Phone:607-722-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist