MEDICARE: WATTERS VISION CARE INC

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	3123	WA

General Provider Information

NPI Number	:	1912235078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATTERS VISION CARE INC

Provider Business Mailing Address
First Line	:	101 NW 12TH AVE
Second Line	:	SUITE 101
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-9141
Country	:	US
Telephone Number	:	360-687-0755
Fax Number	:	360-666-8664

Provider Business Practice Location Address
First Line	:	101 NW 12TH AVE
Second Line	:	SUITE 101
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-9141
Country	:	US
Telephone Number	:	360-687-0755
Fax Number	:	360-666-8664

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN LYNN WATTERS
Credential	:
Telephone Number	:	360-687-0755

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	06/07/2010

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