Provider Demographics
NPI:1407103690
Name:WATSON, KAILEE K (OD)
Entity Type:Individual
Prefix:DR
First Name:KAILEE
Middle Name:K
Last Name:WATSON
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 1:73211 FRED WARING DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2871
Mailing Address - Country:US
Mailing Address - Phone:760-346-1136
Mailing Address - Fax:760-568-1589
Practice Address - Street 1:73211 FRED WARING DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2871
Practice Address - Country:US
Practice Address - Phone:760-346-1136
Practice Address - Fax:760-568-1589
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist