Provider Demographics
NPI:1841397924
Name:WATSON, BARRY B (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:B
Last Name:WATSON
Suffix:
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 1:2500 W STONE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-2356
Mailing Address - Country:US
Mailing Address - Phone:423-246-2733
Mailing Address - Fax:423-245-3319
Practice Address - Street 1:2500 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-2356
Practice Address - Country:US
Practice Address - Phone:423-246-2733
Practice Address - Fax:423-245-3319
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD 1137152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist