MEDICARE: DR. MEGAN MICHELLE WATTERS 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	11325193-9934	UT

General Provider Information

NPI Number	:	1508409830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN MICHELLE WATTERS OD

Provider Business Mailing Address
First Line	:	680 SUGUARO BLUFFS ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2670
Country	:	US
Telephone Number	:	719-930-3196
Fax Number	:

Provider Business Practice Location Address
First Line	:	3051 GARDEN AVE BLDG 1279
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-7537
Country	:	US
Telephone Number	:	719-930-3196
Fax Number	:

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

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	06/16/2023

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