Provider Demographics
NPI:1518954510
Name:WATSON, O A JR (OD)
Entity Type:Individual
Prefix:DR
First Name:O
Middle Name:A
Last Name:WATSON
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5551
Mailing Address - Country:US
Mailing Address - Phone:512-396-3737
Mailing Address - Fax:512-396-3745
Practice Address - Street 1:121 W SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5551
Practice Address - Country:US
Practice Address - Phone:512-396-3737
Practice Address - Fax:512-396-3745
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2196T152WV0400X
CO2470152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E89BOtherBLUE CROSS BLUE SHIELD
TX5123963737OtherVSP
TX00E89BOtherBLUE CROSS BLUE SHIELD
TX5123963737OtherVSP