Provider Demographics
NPI:1508409830
Name:WATTERS, MEGAN MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MICHELLE
Last Name:WATTERS
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:680 SUGUARO BLUFFS ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2670
Mailing Address - Country:US
Mailing Address - Phone:719-930-3196
Mailing Address - Fax:
Practice Address - Street 1:3051 GARDEN AVE BLDG 1279
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-7537
Practice Address - Country:US
Practice Address - Phone:719-930-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT11325193-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist