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NPI Code Detail

MEDICARE: DR. ALEC CHRISTOPHER WATERS OD

MEDICARE: DR. ALEC CHRISTOPHER WATERS OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1538NE

General Provider Information

NPI Number : 1023685617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALEC CHRISTOPHER WATERS OD
Provider Business Mailing Address
First Line : 3610 W NORFOLK AVE
Second Line :
City : NORFOLK
State : NE
Zip : 68701-7702
Country : US
Telephone Number : 402-371-8230
Fax Number : 402-371-3911
Provider Business Practice Location Address
First Line : 401 N EDDY ST
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68801-4558
Country : US
Telephone Number : 308-384-6922
Fax Number : 308-384-7824
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2021
Last Update Date : 06/10/2021

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