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General NPI Number Information
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NPI Number | 1891976379
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Entity Type | Organization
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Legal Business Name | LAWRENCE C WATSON OD A PROFESSIONAL OPTOMETRIC CORP.
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 73211 FRED WARING DR STE 102
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City | PALM DESERT
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State | CA
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Zip | 92260-2871
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Country | US
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Telephone | 760-346-1136
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Fax | 760-568-1589
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Provider Business Mailing Address
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Address Line | 73211 FRED WARING DR STE 102
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City | PALM DESERT
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State | CA
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Zip | 92260-2871
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE WATSON
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Credential | OD
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Telephone | 760-346-1136
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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 | OPT5967TPL
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License Number State | CA
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