Provider Demographics
NPI:1629398516
Name:WATT, TONI LYNN (OD)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:LYNN
Last Name:WATT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2075
Mailing Address - Country:US
Mailing Address - Phone:503-701-8323
Mailing Address - Fax:
Practice Address - Street 1:2610 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2075
Practice Address - Country:US
Practice Address - Phone:507-373-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist