MEDICARE: CALEB WATSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2899	NC

General Provider Information

NPI Number	:	1841161783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB WATSON OD

Provider Business Mailing Address
First Line	:	111 E 4TH ST STE 440
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6206
Country	:	US
Telephone Number	:
Fax Number	:	314-741-4947

Provider Business Practice Location Address
First Line	:	312 E CENTERVIEW ST
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2553
Country	:	US
Telephone Number	:	704-857-5464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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