Provider Demographics
NPI:1437370996
Name:WATSON, STEPHANIE C (LDO)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:C
Last Name:WATSON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SOUTHERN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-1451
Mailing Address - Country:US
Mailing Address - Phone:813-659-0119
Mailing Address - Fax:813-719-3298
Practice Address - Street 1:107 SOUTHERN OAKS DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1451
Practice Address - Country:US
Practice Address - Phone:813-659-0119
Practice Address - Fax:813-719-3298
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4631156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1248240001Medicare NSC