Provider Demographics
NPI:1083761928
Name:WATSON'S OPTICAL INC.
Entity Type:Organization
Organization Name:WATSON'S OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-242-2721
Mailing Address - Street 1:RT 22 CROOKED CREEK ROAD
Mailing Address - Street 2:RR4 BOX 250 SUITE 2
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652
Mailing Address - Country:US
Mailing Address - Phone:717-242-2721
Mailing Address - Fax:717-242-3510
Practice Address - Street 1:RT 22 CROOKED CREEK ROAD
Practice Address - Street 2:BOX 250 SUITE 2
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652
Practice Address - Country:US
Practice Address - Phone:717-242-2721
Practice Address - Fax:717-242-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA288845OtherBLUE SHIELD
PA0008462640001Medicaid
PA0008462640001Medicaid
PA288845OtherBLUE SHIELD