Provider Demographics
NPI:1619021375
Name:WATERS, ASHLEY MONIQUE
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:MONIQUE
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12278 PLANK ROAD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811
Mailing Address - Country:US
Mailing Address - Phone:225-775-9406
Mailing Address - Fax:225-775-0258
Practice Address - Street 1:12278 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811
Practice Address - Country:US
Practice Address - Phone:225-775-9406
Practice Address - Fax:225-775-0258
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1978884Medicaid