Provider Demographics
NPI:1184282592
Name:WATSON, MARLIE ELIZABETH (OD)
Entity type:Individual
Prefix:MRS
First Name:MARLIE
Middle Name:ELIZABETH
Last Name:WATSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARLIE
Other - Middle Name:ELIZABETH
Other - Last Name:MOCHAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-0948
Mailing Address - Country:US
Mailing Address - Phone:207-778-6925
Mailing Address - Fax:207-778-0578
Practice Address - Street 1:112 NARROW GAUGE SQ
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-5824
Practice Address - Country:US
Practice Address - Phone:207-778-2020
Practice Address - Fax:207-778-0578
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT1008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist