Provider Demographics
NPI:1881683407
Name:WATSON, RONALD RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RAYMOND
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 1:43 KRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1035
Mailing Address - Country:US
Mailing Address - Phone:810-648-3100
Mailing Address - Fax:
Practice Address - Street 1:43 KRISTIAN ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1035
Practice Address - Country:US
Practice Address - Phone:810-648-3100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0198800001OtherADMINASTAR
0198800001OtherADMINASTAR
U33341Medicare UPIN