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General NPI Number Information
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NPI Number | 1093028219
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Entity Type | Organization
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Legal Business Name | ROBERTSON OCULAR WATTERS CREEK LLC
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 918 WATTERS CREEK BLVD
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City | ALLEN
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State | TX
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Zip | 75013-3734
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Country | US
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Telephone | 214-495-0095
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Fax | 214-785-6651
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Provider Business Mailing Address
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Address Line | 941 W BETHANY DR
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City | ALLEN
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State | TX
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Zip | 75013-3739
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Country | US
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Telephone | 214-495-0095
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Fax | 214-785-6651
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REID ANDREW ROBERTSON
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Credential | O.D.
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Telephone | 214-495-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7583T
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License Number State | TX
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