Provider Demographics
NPI:1437159910
Name:WATSON, CATHERINE PACE (OD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:PACE
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:EAST DOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05341-0022
Mailing Address - Country:US
Mailing Address - Phone:631-379-9179
Mailing Address - Fax:
Practice Address - Street 1:218 LOWER MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-8110
Practice Address - Country:US
Practice Address - Phone:802-655-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21310-875152W00000X
NYVUT004693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC33581Medicare ID - Type Unspecified
NYT49122Medicare UPIN