MEDICARE: ROBERTSON OCULAR WATTERS CREEK LLC

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
1	152W00000X	Optometrist	7583T	TX

General Provider Information

NPI Number	:	1093028219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTSON OCULAR WATTERS CREEK LLC

Provider Business Mailing Address
First Line	:	941 W BETHANY DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-3739
Country	:	US
Telephone Number	:	214-495-0095
Fax Number	:	214-785-6651

Provider Business Practice Location Address
First Line	:	918 WATTERS CREEK BLVD
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-3734
Country	:	US
Telephone Number	:	214-495-0095
Fax Number	:	214-785-6651

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REID ANDREW ROBERTSON
Credential	:	O.D.
Telephone Number	:	214-495-0095

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	01/07/2021

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