Healthcare Provider Details

I. General information

NPI: 1043227945
Provider Name (Legal Business Name): CHRISTINE MARY WATSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCDONALD ARMY HEALTH CENTER BLDG. 576 JEFFERSON AVENUE
FT. EUSTIS VA
23604-7620
US

IV. Provider business mailing address

4801 COTSWOLD CT
WILLIAMSBURG VA
23188-5702
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7620
  • Fax: 757-314-7913
Mailing address:
  • Phone: 757-645-5853
  • Fax: 757-314-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMD1435
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: