Healthcare Provider Details

I. General information

NPI: 1073444121
Provider Name (Legal Business Name): EYEPHYSICIANS & FACIAL PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 N MAIN ST STE 10
DAYTON OH
45415-2558
US

IV. Provider business mailing address

PO BOX 1314
DAYTON OH
45401-1314
US

V. Phone/Fax

Practice location:
  • Phone: 937-274-2733
  • Fax: 937-274-2737
Mailing address:
  • Phone: 937-274-2733
  • Fax: 937-274-2737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN JEROME WATT
Title or Position: OWNER/OPHTHALMOLOGIST
Credential: MD
Phone: 937-274-2733