Provider Demographics
NPI:1821274606
Name:DONALD L WATSON, OD AND ASSOCIATES, PC
Entity Type:Organization
Organization Name:DONALD L WATSON, OD AND ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-352-9356
Mailing Address - Street 1:7203 HODGSON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1504
Mailing Address - Country:US
Mailing Address - Phone:912-352-9356
Mailing Address - Fax:912-352-9105
Practice Address - Street 1:7203 HODGSON MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1504
Practice Address - Country:US
Practice Address - Phone:912-352-9356
Practice Address - Fax:912-352-9105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000891382BMedicaid
GAGRP4529Medicare PIN
GA000891382BMedicaid
GA5481640001Medicare NSC