| Name: | Melissa A Gibson Shotts Optometrist, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 Dec 2011 (13 years ago) |
| Entity Number: | 000-035-198 |
| Register Number: | 000035198 |
| County: | Marion |
| Place of Formation: | Marion County |
| Principal Address: | 215 SUNRISE STHAMILTON, AL 35570 |
| Principal Address ZIP Code: | 35570 |
Activities
ENGAGE IN THE PROFESSTION OF OPTOMETRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487191243 | 2017-01-31 | 2020-03-02 | PO BOX 1807, HAMILTON, AL, 355701807, US | 1925 MILITARY ST S, HAMILTON, AL, 355706674, US | |||||||||||||||||||||||||
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| Phone | +1 205-921-7426 |
| Fax | 2059217589 |
Authorized person
| Name | DR. MELISSA A SHOTTS |
| Role | OWNER |
| Phone | 2054125509 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S-C36-TA-873 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 199936 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SHOTTS, MELISSA A | Agent | 215 SUNRISE STHAMILTON, AL 35570 |
| Name | Role | Address |
|---|---|---|
| SHOTTS, MELISSA A | Organizer | 215 SUNRISE STHAMILTON, AL 35570 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
