Provider Demographics
NPI:1932279379
Name:WATSON, RONALD M (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
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 1:10012 ANOEL CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3101
Mailing Address - Country:US
Mailing Address - Phone:619-466-3000
Mailing Address - Fax:
Practice Address - Street 1:3653 AVOCADO BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7337
Practice Address - Country:US
Practice Address - Phone:619-660-6000
Practice Address - Fax:619-660-6002
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA5791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330894018OtherVSP ID NUMBER
CA03516OtherMEDICAL EYE SERVICES
CACA5791OtherEYEMED VISION
CA0937OtherVISION PLAN AMERICA
ARCA95791OtherVISION BENEFITS OF AMERIC
CASD0057910Medicaid
CA17407OtherSPECTERA
CAWY6305AMedicare ID - Type UnspecifiedGROUP MEDICARE ID NUMBER
CA17407OtherSPECTERA