Healthcare Provider Details

I. General information

NPI: 1447294558
Provider Name (Legal Business Name): TORRENCE A WATKINS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N ESTRELLA PKWY STE A105
GOODYEAR AZ
85338-9276
US

IV. Provider business mailing address

955 W SOUTHERN AVE STE 101
MESA AZ
85210-4903
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-0428
  • Fax:
Mailing address:
  • Phone: 480-961-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-001205
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberP0580A
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: