Provider Demographics
NPI:1023685617
Name:WATERS, ALEC CHRISTOPHER (OD)
Entity type:Individual
Prefix:DR
First Name:ALEC
Middle Name:CHRISTOPHER
Last Name:WATERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3610 W NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-7702
Mailing Address - Country:US
Mailing Address - Phone:402-371-8230
Mailing Address - Fax:402-371-3911
Practice Address - Street 1:401 N EDDY ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-4558
Practice Address - Country:US
Practice Address - Phone:308-384-6922
Practice Address - Fax:308-384-7824
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1538152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist