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General NPI Number Information
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NPI Number | 1881683407
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Entity Type | Individual
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Provider Name | RONALD RAYMOND WATSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 43 KRISTIAN ST
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City | SANDUSKY
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State | MI
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Zip | 48471-1035
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Country | US
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Telephone | 810-648-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 43 KRISTIAN ST
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City | SANDUSKY
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State | MI
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Zip | 48471-1035
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Country | US
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Telephone | 810-648-3100
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Fax |
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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 | 4901002880
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License Number State | MI
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