Provider Demographics
NPI:1922155902
Name:RONALD M WATSON, OD, INC
Entity Type:Organization
Organization Name:RONALD M WATSON, OD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-660-6000
Mailing Address - Street 1:1033 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3515
Mailing Address - Country:US
Mailing Address - Phone:619-477-2771
Mailing Address - Fax:619-477-1680
Practice Address - Street 1:1033 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3515
Practice Address - Country:US
Practice Address - Phone:619-477-2771
Practice Address - Fax:619-477-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA5791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA5791OtherEYEMED VISION
CASD0057911Medicaid
CA3515OtherMEDICAL EYE SERVICES
CA3515OtherMEDICAL EYE SERVICES
CACA5791OtherEYEMED VISION