MEDICARE: JOHN A WATERS MD

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	207W00000X	Ophthalmology Physician	382908096	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180250173	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396706925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A WATERS MD

Provider Business Mailing Address
First Line	:	5055 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2922
Country	:	US
Telephone Number	:	810-732-2272
Fax Number	:	810-732-8470

Provider Business Practice Location Address
First Line	:	5055 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2922
Country	:	US
Telephone Number	:	810-732-2272
Fax Number	:	810-732-8470

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/12/2010

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Directions to “ JOHN A WATERS MD” Practice Location

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