Provider Demographics
NPI:1962736660
Name:LOTT, JOHNNY H JR (OD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:H
Last Name:LOTT
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 POINT MALLARD DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6741
Mailing Address - Country:US
Mailing Address - Phone:954-937-6101
Mailing Address - Fax:
Practice Address - Street 1:2301 POINT MALLARD DR SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6741
Practice Address - Country:US
Practice Address - Phone:954-937-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C01-TA-834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist