Provider Demographics
NPI:1467413617
Name:WATSON DRY EYE CENTER, PA
Entity Type:Organization
Organization Name:WATSON DRY EYE CENTER, PA
Other - Org Name:WATSON EYE ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-231-0424
Mailing Address - Street 1:512 SHADY CIRCLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1715
Mailing Address - Country:US
Mailing Address - Phone:252-231-0424
Mailing Address - Fax:252-231-0580
Practice Address - Street 1:11081 WAKE FOREST DRIVE
Practice Address - Street 2:SUITE112
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7655
Practice Address - Country:US
Practice Address - Phone:252-231-0424
Practice Address - Fax:252-231-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890285GMedicaid
NC0285GOtherBCBS
NC2309073Medicare PIN