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General NPI Number Information
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NPI Number | 1700856861
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Entity Type | Individual
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Provider Name | MARK RAYMOND WATSON OD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 3175 CHENEY HWY
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City | TITUSVILLE
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State | FL
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Zip | 32780-5979
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Country | US
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Telephone | 321-383-8040
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Fax | 321-267-1544
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Provider Business Mailing Address
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Address Line | 3437 DEER OAK CIR
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City | OVIEDO
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State | FL
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Zip | 32766-8111
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Country | US
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Telephone | 904-589-8512
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Fax | 904-579-4268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC-4076
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License Number State | FL
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