Provider Demographics
NPI:1902843212
Name:WATERS, MEGAN L (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:L
Last Name:WATERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15540 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3806
Mailing Address - Country:US
Mailing Address - Phone:734-422-5855
Mailing Address - Fax:734-424-0097
Practice Address - Street 1:15540 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3806
Practice Address - Country:US
Practice Address - Phone:734-422-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902843212OtherVSP,EYEMED,NVA,DAVIS,SPECTERA