Individual
AUDREY THOMPSON OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
5002 HIGHWAY 39 N, BUILDING B, MERIDIAN, MS 39301-1078
(601) 483-7331
(601) 483-3721
Mailing address
14994 W MAIN ST BLDG B, LOUISVILLE, MS 39339-2616
(662) 773-3494
(662) 779-4030
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
897
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07608766
—
MS
Enumeration date
04/24/2013
Last updated
04/12/2022
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