Provider Demographics
NPI:1144228172
Name:WATTS, CECIL E (OD)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:E
Last Name:WATTS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4802
Mailing Address - Country:US
Mailing Address - Phone:501-268-3596
Mailing Address - Fax:501-268-7387
Practice Address - Street 1:2914 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4802
Practice Address - Country:US
Practice Address - Phone:501-268-3596
Practice Address - Fax:501-268-7387
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104708722Medicaid
49021Medicare ID - Type Unspecified
AR0148600001Medicare NSC
ART20264Medicare UPIN