Provider Demographics
NPI:1518919455
Name:WATTS, JAMES W (OD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:WATTS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11945 SAN JOSE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1612
Practice Address - Country:US
Practice Address - Phone:904-262-2249
Practice Address - Fax:904-268-8283
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19263OtherFL BCBS
FLT84137Medicare UPIN
FL0555130001Medicare NSC
FL19263YMedicare PIN