Organization · NPI-2

Dr Mark Raymond Watson PA

Optometrist · Titusville, FL

NPI number1730430877
StatusActive
Last updated in NPPESSep 24, 2014

Details

NPI
1730430877
Entity type
Organization (NPI-2)
Legal business name
Dr Mark Raymond Watson PA
Organization subpart
No
Enumeration date
Sep 28, 2012
Last updated
Sep 24, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X OptometristOPC4076FLYes

Practice location

3175 Cheney Hwy
Titusville, FL 32780-5979

Phone 321-383-8040 · Fax 321-267-1544

Mailing address

3437 Deer Oak Cir
Oviedo, FL 32766-8111

Phone 904-589-8512

Authorized official

Mark Raymond Watson
President
3213838040

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