Provider Demographics
NPI:1083795868
Name:WATKINS, REBECCA MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARY
Last Name:WATKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 POTOMAC DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3122
Mailing Address - Country:US
Mailing Address - Phone:908-647-8134
Mailing Address - Fax:
Practice Address - Street 1:655 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3159
Practice Address - Country:US
Practice Address - Phone:732-636-4222
Practice Address - Fax:732-636-0737
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00587300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086544Medicare ID - Type UnspecifiedOPTOMETRIST