MEDICARE: DR. CELINA CECILE WATSON O.D.

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	2648	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2648	OTHER	AR	ARKANSAS STATE BOARD OF OPTOMETRY

General Provider Information

NPI Number	:	1952614869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELINA CECILE WATSON O.D.

Provider Business Mailing Address
First Line	:	12400 CANTRELL RD
Second Line	:	STE 4
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-1728
Country	:	US
Telephone Number	:	501-414-8923
Fax Number	:	501-353-2711

Provider Business Practice Location Address
First Line	:	12400 CANTRELL RD
Second Line	:	STE 4
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-1728
Country	:	US
Telephone Number	:	501-414-8923
Fax Number	:	501-353-2711

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

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	03/08/2019

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