MEDICARE: ASHLEY WATTS 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
1	152W00000X	Optometrist	5743	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194360362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY WATTS OD

Provider Business Mailing Address
First Line	:	9081 SW 55TH ST
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-5851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 CORTEZ RD W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-1433
Country	:	US
Telephone Number	:	941-753-2323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	11/12/2019

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Directions to “ ASHLEY WATTS OD” Practice Location

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